Impact of viral eradication with sofosbuvir‐based therapy on the outcome of post‐transplant hepatitis C with severe fibrosis

Background & Aims Several studies have shown that new direct‐acting antivirals maintain their efficacy in liver transplant (LT) recipients with severe hepatitis C virus (HCV) recurrence. We determined the clinical impact of sofosbuvir/ribavirin in LT through the changes in liver function and fibrosis state at 24 and 48 weeks after treatment. Methods Between June 2014 and July 2015, 126 patients (30 F3, 96 F4 Metavir stage) were enrolled to receive sofosbuvir + ribavirin (24 weeks, 118 patients) or sofosbuvir + simeprevir + ribavirin (12 weeks, 8 patients); treatment was initiated at a median time of 4.3 years from LT. Median follow‐up after therapy completion was 461 days. Results All 30 F3 patients achieved a sustained virological response at week 24 after treatment (SVR24) and showed a distinct amelioration of the AST‐to‐platelet ratio index (APRI), FIB‐4 and liver stiffness at elastography by week 24 post‐therapy, which were maintained at week 48. Of the 96 F4 cirrhotic patients, 72 (75%) achieved SVR24 accompanied by significant improvement of liver function, which was maintained at week 48 (Child B‐C 22% baseline, 11% week 24, 7% week 48); APRI, FIB‐4 and liver stiffness further improved significantly between weeks 24 and 48 of follow‐up. Among the 77 responders (27 F3, 50 F4) who underwent elastography at baseline and at the end of follow‐up, 39 (50.6%; 18 F3, 21 F4) exhibited a regression in fibrosis stage. Conclusion At about 1 year from the completion of successful sofosbuvir‐based therapy, patients with post‐LT HCV and severe fibrosis experienced a long‐term liver function improvement accompanied by a regression of fibrosis stage in half of them.