Introduction:Sofosbuvir is approved to treat HCV infection in all genotypes with sustained virological response 12 weeks after completion of therapy (SVR12)rates of up to 100%. There is limited data on the safety and efficacy of sofosbuvir therapy in post liver transplant (LT)patients with HCV recurrence especially with genotype 4.Methods:Prospective observational(ongoing)study including adult(≥18 years) post LT patients who received sofosbuvir+ribavirn ±interferon after histologically confirmed HCV recurrence(any genotype(GT)).Primary efficacy endpoint is SVR12.Secondary endpoint include safety, any Adverse Drug Event(ADE),&time until viral clearance.Results:To date, a total of 24 patients (16 (66.6%) GT 4, 1 (4%) GT 2, 1 (4%) mixed GT 1&4 and 6 (25%) GT 1) were included. Mean Age was58, and the cohort included 13 males. Two patients had cirrhosis and 2 had HCC prior to starting therapy and mean baseline HCV RNA was 6.6 log¹⁰ IU/ml.The majority of patients had≥grade2stage2 on liver biopsy. All were treatment experienced. Fifteen patients were treated with pegylated interferon +ribavirin+ sofosbuvir for 12 weeks and the remaining were treated with sofosbuvir+ribavirin for 24 weeks.By week 4, three patients had detectable HCV RNA. One patient had detectable HCV RNA by week 6 and none had viral breakthrough until the end of treatment. Ten patients achieved SVR12 and three patients had a relapse, the rest of the patients have not reached SVR12 yet. The most common ADE was anemia. Seven patients developed severe anemia requiring blood transfusion and 14 patients received erythropoiesis stimulating agents. Leukopenia requiring growth factor therapy developed in 5 patients.Mycophenolate was discontinued in all patients prior to, or during therapy due to the observed increased risk of anemia and leukopenia. There were no episodes of acute or chronic rejection, graft loss during follow up. Complete SVR data will be reported.Conclusion:The use of sofosbuvir+ribavirin±peginterferon was tolerated. 76.9% of the patients included in the analysis achieved the primary end point. However, profound anemia was the main limiting side effect which developed mainly in patients who received sofosbuvir+ribavirin+pegylated interferon.

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