Background: Hepatitis C (HCV) treatment has entered a new phase of excitement with new oral therapies. Here we describe our experience of sofosbuvir (SOF) based therapy in the early, within one year of transplant, and late post transplant setting. Methods: We started 26 patients (pts) on sofosbuvir based therapy for 24 weeks, 19 men and 7 women. 21 caucasian and the remainder hispanic. 8 pts were started early and 18 late ranging from 4 weeks pre-transplant to 24 years post transplant. 16 pts had genotype 1a, 4 genotype 1b, 2 genotype 2, 2 genotype 3, and 2 genotype 1a or 1b. 13 started on SOF 400 mg daily and ribavirin (RBV) 200 mg twice daily (titrated to highest dose tolerated), 12 pts SOF 400 mg daily and simeprevir (SIM) 150 mg daily, one triple therapy with SOF 400mg, RBV 400mg twice daily and interferon 180mcg weekly. Change in therapy was allowed if clinical benefit warranted. Nine had prior history of hepatocellular carcinoma (HCC). Immunosuppression therapy consisted of either tacrolimus or cyclosporine, mycophenolate Mofetil and corticosteroids. 15 of the 26 were interferon experienced.

Results: Pre-treatment HCV-RNA levels ranged from 107k to 44.4 million. 20 of 23 pts with available HCV-RNA were non-detectable (ND) by week 4. The 6 others were all ND by the next visit. 23 have completed therapy. 1 pt on SOF and RBV relapsed and 13 have maintained SVR 12 weeks after completion of treatment. 8 pts pending SVR 12 checkpoint and 4 pts expired, 3 of which were in the late treatment group. Causes of death included massive GI bleed, myocardial infarction, sepsis, and chronic complications of recurrent HCV. 2 other patients receiving SOF/SIM had complications during treatment. One developed late hepatic artery thrombosis at 7 months post-transplant and was re-transplanted. There was no perceivable interference with immunosuppression. One pt had acute rejection on biopsy that responded well to treatment. No recurrence of HCC.

Conclusions: Our experience shows new oral therapies have similar findings of viral clearance reported in the literature. We anticipate that week 12 SVR will also reflect reported clearance rates. Overall the regimen was tolerated well. Larger studies are currently being conducted that will help establish treatment parameters in this population.

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