A261 DIRECT ACTING ANTIVIRAL THERAPY IS EFFECTIVE IN RECURRENT HEPATITIS C IN BOTH TREATMENT NAIVE AND EXPERIENCED LIVER TRANSPLANT RECIPIENTS: CLINICAL AUDIT OF THE ATLANTIC MULTI-ORGAN TRANSPLANT PROGRAM

Abstract Background Hepatitis C virus (HCV) has been the main indication for liver transplantation (LT) with universal recurrence after transplantation and significant morbidity and mortality post LT. The newer interferon-free direct acting antiviral agents have been effective in achieving sustained viral response (SVR). Aims To document the efficacy, safety and tolerability of interferon-free direct acting antiviral agents in the treatment of HCV recurrence in all genotypes in liver transplant patients from Atlantic Canada. Methods As part of quality improvement audit, we searched the AMOTP liver transplant database for all patients with HCV who had undergone LT. We then specifically extracted data on the LT patients who had direct acting antiviral agents initiated to assess efficacy of therapy. Post treatment SVR was determined by HCV RNA levels at week 12. Results Between July 1985 and June 2016, 583 liver transplants were done within the Atlantic Multi-Organ Transplant Program (AMOTP). Of those 119 (20%) recipients were HCV-Antibody positive at time of liver transplant. By end of study period, 62 with HCV-Antibody were still alive. Between July 2014 and August 2016, 24 liver transplantation recipients from across Atlantic Canada with HCV recurrence [defined as positive HCV-RNA by PCR and liver biopsy proven disease showing at least grade 2 (inflammation) and/or stage 2 (fibrosis)] were started on interferon-free orally direct acting antiviral. Most patients (88%) received sofosbuvir (SOF) based regimes (sovaldi + ribavirin (RBV), n=5; SOF + RBV, n=5; SOF + ledipasvir + RBV, n=13; SOF + sovaldi, n=1). The mean age of these patients was 62.8 ± 4.9 years with the majority being genotype 1 (75%) and male (79%). Eighteen of twenty-two (82%) patients have undetectable HCV RNA viral loads at the end of treatment, with two patients still undergoing evaluation. Thirteen of seventeen (76.5%) patients have achieved SVR with 2 non-responders, 1 relapse and 1 early discontinuation due to non-compliance. The remaining 5 patients are still undergoing evaluation. Conclusions Treatment of HCV infected patients with interferon-free regimens after liver transplantation appears efficacious and well tolerated. Funding Agencies None