Efficacy and safety of direct-acting antiviral therapy in previous hard-to-treat patients with recurrent hepatitis C virus infection after liver transplantation: a real-world cohort

Sebastian Bernuth,1 Daniel Grimm,1 Johanna Vollmar,1 Felix Darstein,1 Jens Mittler,2 Michael Heise,2 Maria Hoppe-Lotichius,2 Peter R Galle,1 Hauke Lang,2 Tim Zimmermann1 1First Department of Internal Medicine, Transplant Hepatology, 2General-, Abdominal- and Transplant- Surgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany Background: Recurrent hepatitis C virus (HCV) infection after liver transplantation (LT) has been a frequent and relevant problem in the past two decades. This analysis evaluated the efficacy and safety of new interferon (IFN)-free direct-acting antiviral (DAA) therapies in a large real-world cohort of HCV patients after LT.Methods: We retrospectively analyzed a cohort of 157 patients infected with HCV who underwent deceased donor LT between 1997 and 2014. Patient survival, outcome, and side effects of antiviral therapy were assessed.Results: Survival with recurrent HCV genotype 1 (GT1) infection was inferior to other HCV GTs (P=0.01). The overall sustained virological response (SVR) rate with new DAA therapy was 94.6% (n=37). Patients with both GT1 and other GTs reached SVR rates >90%. We noticed a few side effects, mainly caused by ribavirin, and only one discontinuation in DAA-treated patients.Conclusion: DAA therapy was effective and safe in previous hard-to-treat patients after LT in this real-world cohort. Keywords: HCV, DAA, liver transplantation, reinfection, sustained virological response, SVR