Multidisciplinary Approach to treat Liver Transplant Recipients with Hepatitis C using Sofosbuvir based Therapy

Abstract

Introduction: The safety and efficacy of the direct acting antivirals in liver transplant recipients is unknown. Materials and Methods:Retrospective cohort study on 44 liver transplant recipients, ≥18 years old who received Sofosbuvir (SOF) based antiviral therapy (AVT) at our hospital from January 2012 through May 2016. Multidisciplinary (MDT) approach involving hepatologists, transplant pharmacists and a patient access coordinator was adapted. SVR at 12 and 24 weeks, safety and compliance of SOF based AVT were reported. We also reported on improvement in APRI and CPT score at SVR.Results: 35 patients (79.5%) were treated with Ledipasvir (LDV) /SOF, 7 (16 %) with SOF/RBV and 2 (4.5%) with SOF/Simeprevir (SIM). Most patients were HCV genotype 1 (n=37; 84.1%) and treatment experienced (n= 24; 55%). Median time between liver transplant (LT) and AVT was 2.7 years with majority (66%) treated ≥ 12 months after LT. Median pre-treatment HCV viremia was 3,800,000 (71,000-66,000,000) with a high viral load ≥ 800,000 copies/ml in 36 (82%) patients. SVR 12 and 24 were achieved in 43/44 (98%), despite a low (77.3%) rapid virological response. Statistically significant improvement was observed in pre-treatment and post-SVR median albumin levels, APRI and CPT scores. Fatigue (27%) was the most commonly reported adverse effect. Compliance rate was 100%. Conclusion:With a MDT approach, using SOF based AVT, a very high SVR was achieved in liver transplant recipients with recurrent HCV infection. A MDT approach positively impacts medication acquisition, enhances patient education and compliance in post LT HCV management.