Acute cellular rejection following liver transplantation has decreased in incidence with the use of potent immunosuppressive agents, affecting less than 25 percent of liver transplantation recipients. HCV recurrence following liver transplantation has been shown to lead to late graft loss. We have previously shown a sustainable viral response (SVR) in post liver transplant HCV patients after treatment with Sofosbuvir/Ribavirin for 24 wks. Recently we studied 51 recipients with detectable HCV viral load at the time of liver transplant, who were treated with either Sofosbuvir/Ribavirin or Sofosbuvir/Ledipasvir post-transplant. The incidence of acute cellular rejection in the setting of SVR between two treatment groups was compared.

51 liver transplant recipients with detectable viral load were enrolled in this study (Two patients were excluded; one lost to follow up and the other never achieved SVR). Age, sex, viral load, genotype, previous treatment, time to seroconversion and rejection episodes were reviewed. Tolerance to treatment, side effects, dose adjustments, immunosuppression changes, and sustainability of viral response were monitored. Patients treated either with Sofosbuvir 400mg and Ribavirin 600mg or Sofosbuvir 400mg and Ledipasvir 90mg were analyzed in two separate groups. Length of treatment was 24 weeks (7 patients had shorter treatment due to insurance coverage). Average time for viral clearance was 4.3 weeks after the initiation of anti-viral therapy. All patients were followed for at least three months after the completion of treatment. No incidence of acute cellular rejection was observed among 35 patients treated with Sofosbuvir/Ribavirin during the first 36 week period after the initiation of treatment. In clear contrast, four out of the remaining sixteen patients treated with Sofosbuvir/Ledipasvirsuffered from an ACR episode within a two week period after they achieved SVR (0% vs 25%, p<0.005).

Sofosbuvir/Ribavirin and Sofosbuvir/Ledipasvirfor 24 wks are effective and well tolerated treatment regimens to achieve SVR among liver recipient patients. Nevertheless, effective treatment of HCV with Sofosbuvir/Ledipasvir appears to increase the incidence of acute cellular rejection shortly after the achievement of SVR. It may be warranted to increase immunosuppression shortly after clearance of virus has taken place.

CITATION INFORMATION: Bortecen K, Layman R, Gelb B, Winnick A, Morgan G, Tobias H, Teperman L. A Sustained Viral Response Achieved with Sofosbuvir/Ledipasvir May Increase the Incidence of Acute Cellular Rejection Post Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).

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