Background: Treatment of acute cellular rejection (ACR) in patients with orthotopic liver transplantation (OLT) secondary to hepatitis C virus (HCV) remains a major challenge due to clinicians' fear of corticosteroids increasing HCV infectivity and reactivity. Direct-acting antiviral agents (DAAs) offer significant advantages over peg-interferon and ribavirin, achieving sustained viral response (SVR) greater than 90% in treatment-naïve patients with limited duration and improved adverse effect profile. More patients are achieving SVR before undergoing transplant, yet post-transplant outcomes related to HCV remain unclear.

Methods: This is a retrospective, single-center, descriptive chart review of patients who received OLT for HCV-related liver disease between 2010 and 2016 at a 1000-bed quaternary-care academic hospital. Patients with multi-organ transplantation or coinfection with hepatitis B infection or human immunodeficiency virus were excluded. We described rates of suspected ACR and treatment modalities, recurrence of HCV infection and hepatocellular carcinoma (HCC), and patient and graft outcomes within one year post transplantation.

Results: 110 patients were enrolled. At the time of transplant, 69 (62.7%) patients had HCV viremia; 52 (75.4%) of them achieved SVR 12 with primarily sofosbuvir-based DAA regimens post-transplant. Suspected ACR occurred in 14 (12.7%) patients, 9 of whom had achieved SVR prior to the suspected ACR. Treatment consisted of intravenous methylprednisolone and/or hydrocortisone; doses of methylprednisolone were empirically reduced by approximately 50% if patients had positive HCV viremia at the time of treatment. No recurrence of HCV infection after receiving corticosteroids was reported in patients if they had already achieved SVR. Of the study cohort, 66 (60.0%) patients had concurrent HCC at the time of transplant. HCC recurred after transplant in 9 (8.2%) patients, all of which had positive HCV viremia at the time of transplant. One year post-transplant graft and patient survival rates were 95.5% and 91.8%, respectively.

Conclusion: Treatment of ACR with corticosteroids was not associated with recurrent HCV infection post-transplant. DAA treatment achieved satisfactory outcomes in OLT patients with recurrent HCV infection. HCC recurrence post-transplant was present only in patients with HCV viremia at the time of transplant.

CITATION INFORMATION: Chen T., Moaddab M., Pierce B., Ghobrial R. Treatment and Outcomes of Orthotopic Liver Transplant Patients Secondary to Hepatitis C Virus: A Single Center Experience Am J Transplant. 2017;17 (suppl 3).

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