Outcomes of antiviral treatment in hepatitis C virus liver transplant patients off immunosuppression in the direct acting antivirals era: A case series

BackgroundClearance of hepatitis C virus (HCV) under antiviral therapy, including direct-acting antivirals (DAAs), has been associated with higher risk of rejection. Whether patients who are not on immunosuppression (IS) during DAA therapy are at higher risk of rejection is unknown. MethodsFour transplant recipients who were off IS and treated with DAA therapy were identified. ResultsAll patients were genotype 1 infection and treated for 12weeks with sofosbuvir/ledipasvir/ribavirin. At the time of DAA therapy, patients were off IS for a median of 9.5years. Time from liver transplant (LT) to treatment was 12.9 years.Median baseline ALT was 70 IU/L, at follow-up week 12 was 18 IU/L. No signs of rejection were observed during DAA therapy or follow-up after the end of therapy. All 4 patients obtained sustained virological response. ConclusionDirect-acting antivirals therapy in HCV patients off IS post-LT can be successfully undertaken without the need to restart IS.