Background & Aims: Hepatitis C virus (HCV) re-infection following liver transplant (LT) is associated with reduced graft and patient survival. Before transplant, Sofosbuvir/Ribavirin (SOF/R) treatment prevents recurrent HCV in 96% of those patients achieving viral suppression for at least 4 weeks before transplant. We evaluated whether a bridging SOF-regimen from pre- to post-transplant is safe and effective to prevent HCV recurrence in those patients with less than 4 weeks of HCV-RNA undetectability at the time of transplant. Methods: From July 2014 SOF/R was given in 233 waitlisted HCV cirrhotics with/without hepatocellular carcinoma (HCC) within an Italian Compassionate Program. One hundred patients were transplanted and 31 patients (31%) treated with SOF/R bridging therapy were studied. Results: Liver transplant indication in bridge subgroup was HCC in 22 and decompensated cirrhosis in 9. HCV-genotype was 1/4 in 18 patients. SOF 400 mg/day and R (median dosage 800 mg/day) were given for a median of 35 days before LT. At transplant time, 19 patients were still HCV-RNA positive (median HCV-RNA 58 IU/mL). One recipient had a virological breakthrough at week 4 post-transplant; one died, on treatment, 1-month post-transplant for sepsis and 29/31 achieved a 12-week sustained virological response (94%). Acute cellular rejection occurred in three recipients. On September 2016, 30 recipients (97%) were alive with a median follow-up of 18 months (range 13-25). Conclusions: In patients with suboptimal virological response at LT, a bridging SOF/R regimen helps avoiding post-transplant graft reinfection.
Prevention of hepatitis C recurrence by bridging sofosbuvir/ribavirin from pre- to post-liver transplant : a real-life strategy / M.F. Donato, C. Morelli, R. Romagnoli, F. Invernizzi, C. Mazzarelli, R.M. Iemmolo, M. Montalbano, I. Lenci, S. Bhoori, G. Pieri, S. Berardi, P. Caraceni, S. Martini, P. Angeli, L. Saverio Belli, S. Berardi, V. Bernabucci, F. Malinverno, S. Monico, A. Ottobrelli, A. Romano, S. Strona, M.R. Tamè, U.V.M. Cavenago, L. De Carlis, F. Di Benedetto, D. Dondossola, G.M. Ettorre, V. Mazzaferro, U. Montin, A.D. Pinna, G. Rossi, M. Salizzoni, G. Tisone. - In: LIVER INTERNATIONAL. - ISSN 1478-3223. - 37:5(2017 May), pp. 678-683.
|Titolo:||Prevention of hepatitis C recurrence by bridging sofosbuvir/ribavirin from pre- to post-liver transplant : a real-life strategy|
MAZZAFERRO, VINCENZO MARIA [Membro del Collaboration Group]
ROSSI, GIORGIO ETTORE [Membro del Collaboration Group]
|Parole Chiave:||hepatitis C; hepatocellular carcinoma; liver transplant; sofosbuvir therapy; virological response|
|Settore Scientifico Disciplinare:||Settore MED/18 - Chirurgia Generale|
|Data di pubblicazione:||mag-2017|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1111/liv.13322|
|Appare nelle tipologie:||01 - Articolo su periodico|