Recurrent hepatitis C treatment with direct acting antivirals – a real life study at a Brazilian liver transplant center

Recurrent hepatitis C (HCV) after liver transplantation (LT) is an important cause of morbidity and mortality. Antiviral treatment is recommended to avoid unfavorable outcomes. Direct-acting antivirals (DAA) have transformed HCV treatment, with higher efficacy and fewer side-effects than interferon-based therapies traditionally used. To evaluate DAA treatment outcomes at a Brazilian transplant unit, data of patients who finished HCV treatment at the Liver Transplant Unit of the University of Campinas were analyzed. Treatment consisted of sofosbuvir, daclatasvir, and ribavirin, for 12 or 24 weeks, according to the national guidelines. Fifty-five patients completed antiviral treatment and 54 had HCV-viral load results available. The majority of patients were male (78%), 58 years old on average, 65% had hepatocellular carcinoma (HCC) before LT, and 67% were interferon treatment-experienced. Most patients had HCV genotype 1 (65%), 35% had genotype 3, and started treatment on an average of 38 months after LT (range: 2–228). Fifty-eight percent were treated for 12 weeks and 42% for 24 weeks, using a mean dose of ribavirin of 10.1 mg/kg (4.2–16.1). There were no treatment interruptions due to serious side effects. The sustained virological response rate was 98%. Only one patient relapsed, a genotype 3 cirrhotic treated for 12 weeks. The average follow-up after starting antivirals was 20 months. There were no recurrences of HCC, but there was one rejection episode and one cirrhosis decompensation episode, both 12 weeks after treatment. DAA treatment is safe and effective in the post-LT setting and was not associated to HCC recurrence in the cohort studied.

肝移植（liver transplantation, LT）术后复发性丙型肝炎（hepatitis C, HCV）是引发患者发病与死亡的重要诱因。为避免不良预后，临床推荐采用抗病毒治疗。直接作用抗病毒药物（direct-acting antivirals, DAA）彻底改变了HCV的治疗方案，相较于传统使用的基于干扰素的治疗方案，其疗效更优且不良反应更少。为评估巴西某移植中心的DAA治疗效果，本研究对坎皮纳斯大学肝移植中心完成HCV治疗的患者数据进行了分析。治疗方案依据巴西国家指南，采用索磷布韦（sofosbuvir）、达卡他韦（daclatasvir）联合利巴韦林（ribavirin），疗程设置为12或24周。共有55例患者完成抗病毒治疗，其中54例具备HCV病毒载量检测结果。受试者中多数为男性（78%），平均年龄58岁；65%的患者在肝移植术前罹患肝细胞癌（hepatocellular carcinoma, HCC），67%有干扰素治疗史。多数患者的HCV基因型为1型（65%），35%为3型；患者平均在肝移植术后38个月时启动抗病毒治疗（范围：2~228个月）。58%的患者疗程为12周，42%为24周，利巴韦林的平均给药剂量为10.1mg/kg（范围：4.2~16.1mg/kg）。无患者因严重不良反应终止治疗。持续病毒学应答（sustained virological response, SVR）率达98%，仅1例患者出现复发，该患者为基因型3型肝硬化患者，接受12周疗程治疗。抗病毒治疗启动后的平均随访时长为20个月。未观察到肝细胞癌复发，但出现1例排斥反应与1例肝硬化失代偿事件，均发生于治疗后12周。在肝移植术后场景中，DAA治疗安全有效，且在本研究队列中未发现其与肝细胞癌复发存在关联。