This study included 40 patients who underwent living donor liver transplantation that started treatment at least 3 months following transplantation and no prior history of treatment of hepatitis C infection.
This study showed that 100% of patients achieved SVR after treatment of HCV with combined sofosbuvir and daclatasvir.
Poordad and his colleagues showed that 12 weeks of treatment with the pan-genotypic combination of daclatasvir with sofosbuvir and ribavirin achieved SVR12 rates of 83% and 94% in the advanced cirrhosis and post-transplantation cohorts, respectively .
Another study by Pellicelli and his colleagues evaluated the safety and efficacy of sofosbuvir and daclatasvir with or without RBV among 12 post-LT patients with severe recurrent HCV who were treated through an international compassionate use program. Three patients had fibrosing cholestatic HCV and 9 had cirrhosis. The mean MELD at baseline was 22 and the mean Child-Pugh score was 10. During treatment, 3 deaths occurred: one due to rapidly progressive liver failure, one due to gastrointestinal bleeding, and one due to septic shock. Severe adverse events occurred among 4 of the remaining 9 patients and were attributed to the severity of the patients’ underlying liver disease rather than directly to the antiviral treatment. The 9 patients who completed 24 weeks of treatment all had undetectable HCV RNA at the end of treatment. At the time the study was published, post-treatment virologic data was available for 5 patients, all of whom had achieved SVR (24). In this series as well as an additional case report describing the successful treatment of a patient with post-LT fibrosing cholestatic HCV with sofosbuvir and daclatasvir for 24 weeks, there were no apparent drug–drug interactions between DAA and tacrolimus .
High rates of virologic and clinical response were seen in 23 patients with post-LT fibrosing cholestatic HCV treated with sofosbuvir (n = 8) or sofosbuvir and daclatasvir (n = 15) based regimens .
An ongoing prospective multicenter study in France by Manns et al. evaluating the efficacy of sofosbuvir and daclatasvir with or without ribavirin has found high SVR rates in post-LT patients with aggressive recurrent HCV infection .
In a study by Suraweera and his colleagues, they reported data on 130 LT patients who underwent treatment for 12 or 24 weeks. The mean time period between LT and treatment was 74.2 (± 73.5) months. Eleven patients received sofosbuvir and daclatasvir without ribavirin for 12 weeks and had a response rate of 100% at the end of treatment as well as a SVR12 rate of 100%. Sixty-four patients underwent this same regimen for 24 weeks and had a response rate of 100% at the end of treatment and a SVR12 rate of 97%. Three patients received sofosbuvir and daclatasvir with ribavirin for 12 weeks; the end-of-treatment response rate was 67%, with a SVR12 rate of 67%. Fifty-two patients underwent the same regimen for 24 weeks and achieved an end-of-treatment response rate of 98% and a SVR12 rate of 96% .
The authors also concluded that ribavirin did not have a statistically significant influence on SVR and that further prognostic factors needed to be defined. Thirty patients were reported to have experienced severe side effects, with the most common being hematologic toxicity. Two patients died, 1 from diabetic coma and the other from HCV recurrence at 6 weeks post-treatment. Tacrolimus dosing was adjusted in 56% of patients, cyclosporine in 49% of patients, and everolimus in 38% of patients .
In the current study, the initial values of bilirubin, alkaline phosphatase, and liver enzymes were normal at baseline and improved during the treatment period and follow-up. No liver toxicity of the administered antivirals was observed. The values of albumin and platelets are significantly improved during treatment and follow-up.
Also, there were no changes in the ultrasonographic findings noted after starting treatment and there were no hepatic focal lesions detected during treatment or follow-up period.
The study regimen was compatible with multiple immunosuppressive regimens without dose adjustments, and there were no events of graft rejection.
In contrast, Price et al. found that regimens containing the NS3 protease inhibitors simeprevir or paritaprevir can have significant pharmacokinetic interactions with calcineurin inhibitors .
Adverse events during treatment were consistent with the underlying disease; no treatment-specific safety signals were apparent and no serious adverse events were detected due to treatment protocol.
According to data from eight studies being presented at The International Liver Congress™ 2017 in Amsterdam, The Netherlands, there remains continued debate on whether patients are at risk of developing liver cancer after achieving sustained virological response (SVR) with a direct-acting antiviral (DAA) regimen for hepatitis C virus (HCV).
Despite Trépo and his colleagues found initially promising results, more than one study investigating genetic predisposition to liver cancer failed to identify any robust predictor of HCC development in HCV patients that can be used in clinical practice to optimize the management of patients with a liver cancer .
There was a decreased risk of HCC with antiviral treatment that was based on clinical trial data using INF-based regimens, but recently, results of studies linking the use of DAA therapy with an increased risk of HCC present an interesting dilemma for clinicians .
In the current study, no development of HCC was noted in the studied group.