Introduction: Hepatitis C remains an important source of morbidity and mortality post liver transplant. Little is known about the long term effects of direct acting antiviral therapy in patients after liver transplant. We examined the incidence and severity of acute cellular rejection (ACR) in patients treated for HCV post liver transplantation relative to the incidence and severity of ACR in all liver transplant patients. Methods: We created a database of patients that received a liver transplant (LT) due to underlying HCV, and were being followed by transplant hepatologists at our center. Patients that achieved SVR prior to transplantation, or had a solitary rejection episode prior to initiation of HCV treatment (Tx) were excluded from the analysis. Patients were split into early (Tx w/in 1 year of LT) and late Tx groups (Tx >1 year post LT). Results: 53 patients (39M, 14F) were included in the final analysis. 31 were non-Hispanic White and 16 were Hispanic/Latino. Mean age was 64.7. Patients were treated with predominantly sofosbuvir based regimens without ribavirin, for 12-24 weeks. 39 patients had G1a/b, 8 had G3, and 4 had G2 or G6. 13 patients were treated w/in 1 year of LT. 40 were treated >1 year after LT. Overall, rejection was seen in 5/53 patients (9.4%). 1/13 (7.7%) patients treated w/in 1 year of LT experienced at least one rejection (ACR) episode. Patients in this group were primarily suppressed with tacrolimus and mycophenolate. The patient with an ACR episode had a Banff score of 6, AST at time of ACR was 264, and time from Tx initiation to ACR was 5 months. 4/40 (10%) patients treated >1 year post LT experienced at least one episode of rejection. Patients in this group were primarily immunosuppressed with tacrolimus monotherapy. The mean Banff score was 5.5 (range: 3-8), mean AST at time of ACR was 148.8 (range: 110-196), and the mean time from Tx initiation to ACR was 12.3 months (range: 9-15). All Late-Tx patients required treatment with steroid bolus, and all had slow response with prolonged steroid taper. There were no graft losses or deaths. Conclusions: Tx of HCV >1 year post LT resulted in a rejection rate of 10%, which is higher than the reported incidence of late ACR of ~8%. These rejection episodes were moderate in severity, required steroid bolus, and were difficult to control. Therefore, patients undergoing HCV Tx >1 year post LT should be monitored closely both during, and after the completion of Tx.

CITATION INFORMATION: Skillin C, Mba M, Madani B, Frenette C. Effect of Hepatitis C (HCV) Treatment on Rejection Incidence and Severity in Post-Liver Transplant Patients. Am J Transplant. 2017;17 (suppl 3).

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