Treating fibrosing cholestatic hepatitis C with sofosbuvir and ribavirin: a matched analysis

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.