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Pre-emptive Treatment of HCV after Living Donor Liver Transplantation with Direct-Acting Antiviral Agents

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Hepatitis C virus (HCV) universally recurs after liver transplantation (LT). Although the introduction of direct-acting antiviral agents (DAAs) has revolutionized the treatment of HCV infection, no optimal treatment for HCV recurrence after LT has been developed.

Methods

This study retrospectively evaluated the efficacy of DAAs as a pre-emptive treatment for recurrent HCV infection after living donor liver transplantation (LDLT). From January 2010 to December 2016, 70 patients received pegylated interferon (PegIFN) and 35 patients were treated with DAA-based regimens to treat recurrent HCV after LDLT. All antiviral treatments were pre-emptive.

Results

Genotype 1b was the most common HCV type (61.9%). Twenty-two recipients in the DAA group were treated with ledipasvir/sofosbuvir, nine received daclatasvir plus asunaprevir, three received sofosbuvir, and one received sofosbuvir plus daclatasvir. All 35 patients (100%) in the DAA group achieved a sustained virologic response (SVR), a percentage significantly higher than that (71.4%) in the PegIFN group (p < 0.001). In the PegIFN group, the 1-, 3-, and 5-year graft survival rates were 85.7, 73.9, and 70.7%, respectively, whereas those in the DAA group were 100, 100, and 100%, respectively (p = 0.008).

Conclusion

DAA-based regimens are an effective treatment for HCV recurrence after LDLT, resulting in an improved SVR and better graft survival than PegIFN.

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Abbreviations

ACR:

Acute cellular rejection

ALDLT:

Adult living donor liver transplant

ASV:

Asunaprevir

CSP:

Cyclosporine

CR:

Chronic rejection

DAA:

Direct-acting antiviral agent

DCV:

Daclatasvir

DDLT:

Deceased donor liver transplant

ETVR:

End-of-treatment virological response

EVR:

Early virologic response

GRWR:

Graft-to-recipient weight ratio

GV:

Graft volume

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

LC:

Liver cirrhosis

LDLT:

Living donor liver transplant

LDV:

Ledipasvir

LT:

Liver transplantation

MELD:

Model for end-stage liver disease

PegIFN:

Pegylated interferon

RNA:

Ribonucleic acid

RVR:

Rapid virologic response

SAE:

Serious adverse event

SLV:

Standard liver volume

SOF:

Sofosbuvir

SVR:

Sustained virologic response

TAC:

Tacrolimus

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Acknowledgments

The research was supported by research funds from the National Research Foundation of Korea (NRF-2015K1A4A3046807).

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Authors and Affiliations

  1. Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Jinmin Jung, Jae Hyun Kwon, Gi-Won Song & Sung-Gyu Lee

  2. Asan Institute for Life Sciences, Asan-Minnesota Institute for Innovating Transplantation, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea

    Eun-Young Tak

  3. Division of Transplantation, Department of Surgery, Asan-Minnesota Institute for Innovating Transplantation, University of Minnesota, Minneapolis, MN, USA

    Vavara A. Kirchner

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  1. Jinmin Jung
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  2. Jae Hyun Kwon
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  5. Vavara A. Kirchner
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Contributions

Our manuscript has six authors, all of whom contributed significantly to this study. Gi-Won Song, Sung-Gyu Lee, and Jae Hyun Kwon made substantial contributions to study conception and design. Jinmin Jung, Eun-Young Tak, and Varvara A. Kirchner participated in data acquisition and analysis. Jinmin Jung, Jae Hyun Kwon, and Gi-Won Song participated in the drafting of the article and critical revisions to ensure appropriate communication of important intellectual content.

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Correspondence to Gi-Won Song.

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Jung, J., Kwon, J.H., Song, GW. et al. Pre-emptive Treatment of HCV after Living Donor Liver Transplantation with Direct-Acting Antiviral Agents. J Gastrointest Surg 22, 1334–1342 (2018). https://doi.org/10.1007/s11605-018-3779-9

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  • DOI: https://doi.org/10.1007/s11605-018-3779-9

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