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Wadhawan M, Vij V, Makki K, Bansal N, Kumar A. Early Acute Severe HCV Recurrence After Transplantation: From Universal Mortality to Cure. J Clin Exp Hepatol 2017; 7:28-32. [PMID: 28348468 PMCID: PMC5357714 DOI: 10.1016/j.jceh.2016.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 10/21/2016] [Indexed: 12/12/2022] Open
Abstract
Acute severe recurrence of hepatitis C virus (HCV) after solid organ transplant is associated with high mortality. Pegylated interferon and ribavirin are suboptimal in treatment of this severe form of recurrence. We report 4 cases of acute severe HCV recurrence (within 6 months after transplant), including 3 cases with fibrosing cholestatic hepatitis treated with sofosbuvir and ribavirin. All four patients achieved a rapid suppression of HCV RNA with a normalization of liver function tests within 4 weeks of starting therapy. All patients were HCV RNA negative at 12 weeks after stopping therapy. The combination was found to be safe as anemia was the only adverse effect, which developed in 2 patients (1 patient required blood transfusion, while another managed with erythropoietin). Sofosbuvir and ribavirin appear to be safe and efficacious in treatment of acute severe HCV recurrence after organ transplant.
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Key Words
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- DAA's, sofosbuvir
- FCH, fibrosing cholestatic hepatitis
- Fibrosing cholestatic hepatitis
- GGTP, gamma glutamyl transpeptidase
- HCV, hepatitis C virus
- IHBR, intrahepatic biliary radicals
- Kidney transplant
- LFT, liver function tests
- LRLT, living-related liver transplant
- Liver transplant
- MMF, mycophenolate mofetil
- MRCP, magnetic resonance cholangiopancreatography
- POD, postoperative day
- TND, target not detected
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Affiliation(s)
- Manav Wadhawan
- Department of Gastroenterology & Hepatology, Fortis Escorts Liver & Digestive Diseases Institute, Delhi/NCR, India,Address for correspondence: Manav Wadhawan, Department of Gastroenterology & Hepatology, Fortis Escorts Liver & Digestive Diseases Institute, Delhi/NCR, India.Department of Gastroenterology & Hepatology, Fortis Escorts Liver & Digestive Diseases InstituteDelhi/NCRIndia
| | - Vivek Vij
- Department of Surgical Gastroenterology & Liver Transplant, Fortis Hospitals (Escorts & Noida), Delhi/NCR, India
| | - Kausar Makki
- Department of Surgical Gastroenterology & Liver Transplant, Fortis Hospitals (Escorts & Noida), Delhi/NCR, India
| | - Nalini Bansal
- Department of Pathology, Fortis Escorts Hospital, Delhi, India
| | - Ajay Kumar
- Department of Gastroenterology & Hepatology, Fortis Escorts Liver & Digestive Diseases Institute, Delhi/NCR, India
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Saab S, Jimenez M, Bau S, Goo T, Zhao D, Durazo F, Han S, El Kabany M, Kaldas F, Tong MJ, Busuttil RW. Treating fibrosing cholestatic hepatitis C with sofosbuvir and ribavirin: a matched analysis. Clin Transplant 2015; 29:813-9. [PMID: 26147216 DOI: 10.1111/ctr.12584] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Fibrosing cholestatic hepatitis (FCH) is an uncommon but potentially fatal complication of recurrent hepatitis C (HCV) in liver transplant recipients. METHODS We matched the treatment outcomes of 10 liver transplant recipients who developed FCH with those of 10 recipients with recurrent HCV without FCH treated with sofosbuvir and ribavirin. RESULTS Baseline mean alanine transaminase, aspartate transaminase, alkaline phosphatase, and total bilirubin were 186 U/L, 197 U/L, 243 U/L, and 6.7 mg/dL, respectively, in the FCH recipients and 82 U/L, 60 U/L, 110 U/L, and 0.99 mg/dL, respectively, in non-FCH recipients. The sustained viral response in FCH and non-FCH recipients was 40% and 80%, respectively. One-yr patient and graft survival rates were 90% and 80%, respectively, in FCH recipients, and 100% in non-FCH recipients. Seven FCH and six non-FCH recipients were treated for anemia with blood transfusion and/or erythropoietin growth factors. CONCLUSION Our results suggest that the use of sofosbuvir and ribavirin is effective and tolerable in liver transplant recipients treated for recurrent FCH. There is a trend of lower sustained viral response, patient survival, and graft survival in the FCH recipients.
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Affiliation(s)
- Sammy Saab
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.,Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA
| | - Melissa Jimenez
- Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA
| | - Sherona Bau
- Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA
| | - Tyralee Goo
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Difan Zhao
- Department of Biostatistics, University of California at Los Angeles, Los Angeles, CA, USA
| | - Francisco Durazo
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.,Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA
| | - Steven Han
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.,Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA
| | - Mohammed El Kabany
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.,Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA
| | - Fady Kaldas
- Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA
| | - Myron J Tong
- Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA.,Liver Center, Huntington Medical Research Institutes, Pasadena, CA, USA
| | - Ronald W Busuttil
- Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA
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