Tuesday July 03, 2018 from 16:30 to 17:30
Sofosbuvir Plus Velpatasvir Combination Therapy for Recurrent Hepatitis C Infection After Sofosbuvir plus Ribavirin Combination Therapy in a Liver Transplant Recipient
Yang Won Nah1, Hyung Woo Park1, In Young Huh2, Neung Hwa Park3.
1Surgery, Ulsan University Hospital, Ulsan, Korea; 2Anesthesiology, Ulsan University Hospital, Ulsan, Korea; 3Internal Medicine, Ulsan University Hospital, Ulsan, Korea
Introduction:The current standard of care for patients with chronic hepatitis C virus (HCV) infection is a combination of direct-acting antiviral agents (DAAs). DAAs are very effective in eradication of HCV, however, HCV relapse in 1% to 15% of patients treated with these drugs. If re-treatment is needed, the most commonly used strategy is Sofosbuvir as backbone therapy plus a drug from a class other than that previously used, for 24 weeks. The authors experienced a case of successful Sofosbuvir plus Velpatasvir combination therapy for recurrent hepatitis C infection after Sofosbuvir plus Ribavirin combination therapy in a liver transplant recipient and report here.
Case: A 45 year old male patient underwent living donor liver transplantation (LDLT) for hepatocellular carcinoma (beyond Milan criteria, 6 in number and 2.5cm the largest) complicating HCV-cirrhosis on May 11 2016. HCV genotype was 2a and viral load was 5.85E4 IU/mL. The LDLT procedure was performed with modified right lobe graft from his daughter who was HCV Ab seronegative. Graft weight was 483g and GRWR was 0.75. Splenic artery was ligated. The patient recovered uneventfully and discharged from the hospital 16 days after the LDLT operation. Sofosbuvir plus Ribavirin combination therapy was begun 15 days after the operation and was lasted for 12 weeks. HCV RT-PCR results showed 7.31E6 the day before drug administration and was not detected 4 weeks after treatment. AST/ALT level was normalized to 36/34 IU/L 8 weeks after treatment or 20 weeks after the operation. Biliary anastomotic stricture developed 21 weeks after the operation and was managed by endoscopic biliary drainage. Twelve weeks after finishing drug treatment, HCV reinfection was identified that HCV RT-PCR and AST/ALT levels were 2.88E5 and 147/181 IU/L. Sofosbuvir plus Velpatasvir combination therapy was begun 1 month later and Viral load decreased rapidly again and not detectable 8 weeks after the new treatment, which was lasted for 12 weeks. Now, 9 months after finishing Sofosbuvir plus Velpatasvir combination therapy the patient is free from HCV and AST/ALT level is 26/18 IU/L.
Conclusion: Sofosbuvir plus Velpatasvir combination therapy maybe effective rescue therapy for recurrent hepatitis C infection after Sofosbuvir plus Ribavirin combination therapy in a liver transplant recipient