Prevention of hepatitis C recurrence by bridging sofosbuvir/ribavirin from pre‐ to post‐liver transplant: a real‐life strategy

Abstract

In patients with suboptimal virological response at LT, a bridging SOF/R regimen helps avoiding post-transplant graft reinfection.

The Italian compassionate use of sofosbuvir in HCV patients waitlisted for liver transplantation: A national real‐life experience

“…HCC was present in 107 patients (48%). As expected, MELD and Child-Pugh score were lower in HCC than non-HCC patients (MELD: 10.5 [6-23] vs 15 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24], Child-Pugh: 7 [5][6][7][8][9][10][11][12] vs 8 [7][8][9][10][11][12] respectively). Nine patients were also positive for the anti-…”

“…The median time to clearance was 4 weeks (min/max 1-28). Seventeen (7.6%) patients received LT (median treatment duration 4 [0-13] weeks) or discontinued prematurely the drugs (median treatment duration 6 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] weeks) when they were still viraemic; two patients failed to clear HCV-RNA and one patient showed a virological breakthrough.…”

Specific issues concerning the management of patients on the waiting list and after liver transplantation

“…In the treatment of patients with HCC and HCV, the main goal of DAA has been to prevent HCV reinfection after LT . Pre‐LT DAA therapy effectively prevented HCV recurrence in 95% of 61 Child‐Pugh A patients, providing a minimum 30‐day period of viral suppression elapsed before LT. A bridging strategy enabled graft reinfection to be prevented in most of the patients enrolled in the Italian ITACOPS study . No solid data exist at present on whether preventing decompensation by eradicating the virus would enable the use of downstaging therapies for HCC.…”

“…Child-Pugh A patients, providing a minimum 30-day period of viral suppression elapsed before LT. A bridging strategy enabled graft reinfection to be prevented in most of the patients enrolled in the Italian ITACOPS study. 165,170 No solid data exist at present on whether preventing decompensation by eradicating the virus would enable the use of downstaging therapies for HCC.…”

Direct-acting agents for hepatitis C virus before and after liver transplantation

“…Donato et al (17) reported that of 31 patients treated with sofosbuvir (400 mg/day) and ribavirin (600-1200 mg/day) for 24 to 48 weeks before liver transplantation, HCV was eradicated in 12 before liver transplantation.…”