Direct acting antivirals (DAAs) have been used for the treatment of hepatitis C (HCV) in liver transplant patients since early on after their approval, however data in real-life settings is limited. Treating HCV after liver transplant may precipitate an immune restoration response, freeing the T-cells that were targeting HCV to recognize and attack the graft. Previous studies have shown treatment of HCV with ledipasvir/sofosbuvir appears to increase the incidence of acute cellular rejection to up to 25% shortly after the achievement of sustained virologic response (SVR). The primary objective of this study was to determine the incidence of acute cellular rejection in liver transplant patients in a single-center who received a DAA for HCV treatment after transplant for at least four weeks.

All adult liver transplant patients who received a DAA for treatment of HCV for at least four weeks from November 5, 2014 to March 1, 2016 were identified. Patients were excluded if they had a multi-organ transplant, HIV coinfection, or previous history of rejection. Charts were reviewed to identify the incidence of acute cellular rejection, SVR at 12 weeks (SVR12), graft loss, and death.

The charts of 130 patients were reviewed. Of the 99 patients eligible for inclusion, the majority were male (73%), Caucasian (75%), and HCV genotype 1 (83%). Eighty-two percent were treated with ledipasvir/sofosbuvir. Less common DAA regimens studied included ledipasvir/sofosbuvir/ribavirin, daclatasvir/sofosbuvir, daclatasvir/sofosbuvir/ribavirin, and sofosbuvir monotherapy in one patient. Seventy-five percent of patients were greater than 12 months post-transplant when they were initiated on DAA therapy. Four of the 99 patients experienced biopsy-proven rejection, which is a rate of 4% and is less than the national average of 15-25%. All four patients who experienced acute cellular rejection were HCV genotype 1a and had been on ledipasvir/sofosbuvir with the addition of ribavirin in one patient. Ninety-four percent of patients achieved SVR12, no patients experienced graft loss, and one patient died of sepsis.

This study did not find an increased incidence of acute cellular rejection in liver transplant patients treated with DAAs for HCV.

CITATION INFORMATION: Bley D., Sagardia L., Ford R., Todd S. Incidence of Acute Cellular Rejection in Liver Transplant Patients Receiving Direct Acting Antivirals for Hepatitis C Treatment Am J Transplant. 2017;17 (suppl 3).

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