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Sofosbuvir and ribavirin before liver re-transplantation for graft failure due to recurrent hepatitis C: a case report.

Vionnet J, Pascual M, Chtioui H, Giostra E, Majno PE, Decosterd LA, Moradpour D - BMC Gastroenterol (2015)

Bottom Line: Treatment with sofosbuvir and ribavirin allowed for rapid negativation of serum HCV RNA and was well tolerated despite advanced liver and moderate renal dysfunction.Therapeutic drug monitoring did not reveal any clinically significant drug-drug interactions.The use of directly acting antivirals may allow for successful liver re-transplantation for recipients who remain decompensated despite virological response and is likely to improve the outcome of liver re-transplantation for end-stage recurrent hepatitis C.

View Article: PubMed Central - PubMed

Affiliation: Service of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland. Julien.Vionnet@chuv.ch.

ABSTRACT

Background: Recurrent hepatitis C virus infection after liver transplantation is associated with reduced graft and patient survival. Re-transplantation for graft failure due to recurrent hepatitis C is controversial and not performed in all centers.

Case presentation: We describe a 54-year-old patient with hepatitis C virus genotype 1b infection and a response to pegylated interferon-α and ribavirin who developed decompensated graft cirrhosis 6 years after a first liver transplantation. Treatment with sofosbuvir and ribavirin allowed for rapid negativation of serum HCV RNA and was well tolerated despite advanced liver and moderate renal dysfunction. Therapeutic drug monitoring did not reveal any clinically significant drug-drug interactions. Despite virological response, the patient remained severely decompensated and re-transplantation was performed after 46 days of undetectable serum HCV RNA. The patient is doing well 12 months after his second liver transplantation and remains free of hepatitis C virus.

Conclusions: The use of directly acting antivirals may allow for successful liver re-transplantation for recipients who remain decompensated despite virological response and is likely to improve the outcome of liver re-transplantation for end-stage recurrent hepatitis C.

No MeSH data available.


Related in: MedlinePlus

Evolution of HCV RNA and MELD score in a 54-year-old patient with end-stage recurrent hepatitis C treated with sofosbuvir (SOF) and ribavirin (RBV) prior to liver re-transplantation. Despite the rapid virological response to SOF and RBV, the recipient remained severely decompensated and liver re-transplantation was performed in January 2014. HCV RNA was undetectable in serum for 46 days prior to liver re-transplantation and remained undetectable on follow-up throughout January 2015 (i.e. more than 1 year post-liver re-transplantation). Re-LT, liver re-transplantation.
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Fig1: Evolution of HCV RNA and MELD score in a 54-year-old patient with end-stage recurrent hepatitis C treated with sofosbuvir (SOF) and ribavirin (RBV) prior to liver re-transplantation. Despite the rapid virological response to SOF and RBV, the recipient remained severely decompensated and liver re-transplantation was performed in January 2014. HCV RNA was undetectable in serum for 46 days prior to liver re-transplantation and remained undetectable on follow-up throughout January 2015 (i.e. more than 1 year post-liver re-transplantation). Re-LT, liver re-transplantation.

Mentions: SOF was provided by Gilead Sciences Inc. (Foster City, CA) on a compassionate use basis and was started at a dose of 400 mg qd at the beginning of November 2013. Given the impaired renal function, RBV was started 3 weeks prior to SOF to ensure tolerability and pursued thereafter at a daily dose of 400-600 mg. As shown in Figure 1, HCV RNA declined rapidly upon the introduction of SOF and became undetectable 3 weeks later. Treatment was well tolerated and there was no need for the administration of erythropoietin.Figure 1


Sofosbuvir and ribavirin before liver re-transplantation for graft failure due to recurrent hepatitis C: a case report.

Vionnet J, Pascual M, Chtioui H, Giostra E, Majno PE, Decosterd LA, Moradpour D - BMC Gastroenterol (2015)

Evolution of HCV RNA and MELD score in a 54-year-old patient with end-stage recurrent hepatitis C treated with sofosbuvir (SOF) and ribavirin (RBV) prior to liver re-transplantation. Despite the rapid virological response to SOF and RBV, the recipient remained severely decompensated and liver re-transplantation was performed in January 2014. HCV RNA was undetectable in serum for 46 days prior to liver re-transplantation and remained undetectable on follow-up throughout January 2015 (i.e. more than 1 year post-liver re-transplantation). Re-LT, liver re-transplantation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4378015&req=5

Fig1: Evolution of HCV RNA and MELD score in a 54-year-old patient with end-stage recurrent hepatitis C treated with sofosbuvir (SOF) and ribavirin (RBV) prior to liver re-transplantation. Despite the rapid virological response to SOF and RBV, the recipient remained severely decompensated and liver re-transplantation was performed in January 2014. HCV RNA was undetectable in serum for 46 days prior to liver re-transplantation and remained undetectable on follow-up throughout January 2015 (i.e. more than 1 year post-liver re-transplantation). Re-LT, liver re-transplantation.
Mentions: SOF was provided by Gilead Sciences Inc. (Foster City, CA) on a compassionate use basis and was started at a dose of 400 mg qd at the beginning of November 2013. Given the impaired renal function, RBV was started 3 weeks prior to SOF to ensure tolerability and pursued thereafter at a daily dose of 400-600 mg. As shown in Figure 1, HCV RNA declined rapidly upon the introduction of SOF and became undetectable 3 weeks later. Treatment was well tolerated and there was no need for the administration of erythropoietin.Figure 1

Bottom Line: Treatment with sofosbuvir and ribavirin allowed for rapid negativation of serum HCV RNA and was well tolerated despite advanced liver and moderate renal dysfunction.Therapeutic drug monitoring did not reveal any clinically significant drug-drug interactions.The use of directly acting antivirals may allow for successful liver re-transplantation for recipients who remain decompensated despite virological response and is likely to improve the outcome of liver re-transplantation for end-stage recurrent hepatitis C.

View Article: PubMed Central - PubMed

Affiliation: Service of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland. Julien.Vionnet@chuv.ch.

ABSTRACT

Background: Recurrent hepatitis C virus infection after liver transplantation is associated with reduced graft and patient survival. Re-transplantation for graft failure due to recurrent hepatitis C is controversial and not performed in all centers.

Case presentation: We describe a 54-year-old patient with hepatitis C virus genotype 1b infection and a response to pegylated interferon-α and ribavirin who developed decompensated graft cirrhosis 6 years after a first liver transplantation. Treatment with sofosbuvir and ribavirin allowed for rapid negativation of serum HCV RNA and was well tolerated despite advanced liver and moderate renal dysfunction. Therapeutic drug monitoring did not reveal any clinically significant drug-drug interactions. Despite virological response, the patient remained severely decompensated and re-transplantation was performed after 46 days of undetectable serum HCV RNA. The patient is doing well 12 months after his second liver transplantation and remains free of hepatitis C virus.

Conclusions: The use of directly acting antivirals may allow for successful liver re-transplantation for recipients who remain decompensated despite virological response and is likely to improve the outcome of liver re-transplantation for end-stage recurrent hepatitis C.

No MeSH data available.


Related in: MedlinePlus