Case Report
Sofosbuvir and Daclatasvir Combination Therapy in a Liver Transplant Recipient With Severe Recurrent Cholestatic Hepatitis C

https://doi.org/10.1111/ajt.12209Get rights and content
Under a Creative Commons license
open archive

Abstract

Recurrent HCV infection following liver transplantation can lead to accelerated allograft injury that is difficult to treat with interferon. The aim of this study is to describe the first ever use of an interferon-free, all oral regimen in a liver transplant recipient with severe recurrent HCV. A 54-year-old male with HCV genotype 1b developed severe cholestatic HCV at 6 months posttransplant with ascites, AST 503 IU/mL, alkaline phosphatase of 298 IU/mL, HCV RNA of 12 000 000 IU/mL, and histological cholestasis with pericellular fibrosis. Sofosbuvir, an HCV polymerase inhibitor (400 mg/day), and daclatasvir, an HCV NS5A replication complex inhibitor (60 mg/day), were co-administered for 24 weeks. Within 4 weeks of initiating treatment, serum HCV RNA levels became undetectable and liver biochemistries normalized with concomitant resolution of ascites. The patient achieved a sustained virological response with undetectable HCV RNA at 9 months posttreatment. During and following treatment, the daily dose and blood level of tacrolimus remained stable and unchanged. The rapid and sustained suppression of HCV replication in this liver transplant recipient provides great promise for the use of combination oral antiviral regimens in other immunosuppressed and interferon refractory HCV patients.

Key words:

Calcineurin inhibitors
direct-acting antiviral agents
hepatitis C
polymerase inhibitors

Abbreviations

AST
aspartate aminotransferase
ALT
alanine aminotransferase
DCV
daclatasvir
HCV
hepatitis C virus
LT
liver transplantation
WBC
white blood count.

Cited by (0)

Author contributions: Concept and design of the study (R.J.F., E.A.H., M.B., R.H.), generation, collection and analysis of data (R.J.F., E.A.H., M.B., H.A., D.D., R.H., W.T.S.), drafting of the manuscript (R.J.F., E.A.H., M.B., R.H., W.T.S.), finalization of manuscript (R.J.F., E.A.H., M.B., H.A., D.D., R.H., W.T.S.).