Purpose: HCV is the leading cause of end-stage liver disease, universally recurring in the post-transplant setting. Studies have shown disappointing results after first generation protease inhibitors treatment. Sofosbuvir, a nucleotide polymerase inhibitor, combined with interferon therapy have shown more promising results. Interferon side-effects continue to be a concern. We studied viral response in post liver transplant HCV patients after treatment with an Interferon-free Sofosbuvir/ Ribavirin regimen for 24 weeks.

Methods: 42 post liver transplant recipients were enrolled. Three were excluded: 1 chronic anemia, 1 renal impairment, 1 insurance issue. All patients were screened for recurrent HCV by liver biopsy. Patients with stage II fibrosis and no rejection were included. Demographics, viral load, genotype and IL28b, previous treatment, time from transplant, time to seroconversion were reviewed. Treatment tolerance, side effects, dose adjustments, immunosuppression changes, SVR were monitored. All patients were treated with Sofosbuvir 400 mg daily and Ribavirin 600 mg initially.

Results: 77% were males. Mean age 62.9 years (52-79). 79.4% had genotype 1a or 1b, 2.5% 2, 15.4% 3 and 2.5% 4. Mean PCR 5,976,590 IU/ml (313- 36,748,000). 7 patients were treatment naïve, 32 patients were previously treated with INF-based regimens. Mean post transplant initiation to treatment was 56 months (3-207). Only one patient failed to complete the study due to acute renal injury.

All patients had early virologic response with mean time to seroconversion 3.8 weeks (1-18). 38 patients had an SVR, only 1 patient with genotype 1 (2.5 %) had recurrence 6 weeks after completion of 24 weeks treatment. 13 patients (33 %) tolerated the treatment without any dose reduction. 15 patients (38 %) suffered mild to moderate fatigue, 12 had Ribavirin dose reduction. 6 patients (15 %) had anemia (Hg < 10 gr/ dl) treated with erythropoietin. 2 patient received transfusions. 1 patient had occasional dizziness and 1 had hyponatremia. All patients were maintained on immunosuppression with minor changes.

Conclusion: Sofosbuvir/ Ribavirin treatment without Interferon for 24 weeks is an effective regimen for recurrent HCV. It is well tolerated and has no significant interaction with immunosuppressive therapy. SVR as high as 97% can be achieved post liver transplant . Further follow up is ongoing.

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