Successful continuation of HCV treatment following liver transplantation.

Background: Guidelines recommend that patients with hepatitis C virus (HCV)-related liver disease be treated for HCV before liver transplant (LT) to eliminate the virus prior to surgery. However, the unpredictability of donor organ availability may limit treatment duration. Interruption of HCV treatment with resumption post-LT is one potential solution which has not been investigated widely. Methods: Patients from 5 clinical centres included in the large, national, noninterventional Hepa-C registry who started treatment with direct-acting antiviral agents (DAAs) while awaiting LT were identified retrospectively and followed up prospectively. Fifteen patients who had treatment interruptions around LT were identified. Results: The majority of patients (12/15) received interferon-free regimens, most commonly sofosbuvir+daclatasvir (8/12), for a total of 24 weeks (13/15). Treatment was discontinued temporarily for a median of 5 (range 2-33) days. Fourteen patients completing 12 weeks of follow-up achieved a sustained virological response (SVR). One patient who died prior to Week 12 posttreatment achieved a response at posttreatment Week 4. Treatment was generally well tolerated. Serious adverse events (SAEs) were recorded in 2/15 patients (anaemia in 1 patient; pneumonia in 1 patient); all arose after LT. Conclusions: Resumption of DAA therapy after a temporary interruption around LT was highly effective, achieving SVR in all patients who completed 12 weeks of posttreatment follow-up. Treatment was generally well tolerated pre and posttransplantation, with a low rate of SAEs. Such a strategy may offer an important new approach to the treatment of patients awaiting LT which may be assessed in future studies. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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