title: Sofosbuvir and ribavirin before liver re-transplantation for graft failure due to recurrent hepatitis C: a case report.
abstract: BACKGROUND
  Recurrent hepatitis C virus infection after liver transplantation is associated with reduced graft and patient survival. Re-transplantation for graft failure due to recurrent hepatitis C is controversial and not performed in all centers.
  
  
  METHODS
  We describe a 54-year-old patient with hepatitis C virus genotype 1b infection and a null response to pegylated interferon-α and ribavirin who developed decompensated graft cirrhosis 6 years after a first liver transplantation. Treatment with sofosbuvir and ribavirin allowed for rapid negativation of serum HCV RNA and was well tolerated despite advanced liver and moderate renal dysfunction. Therapeutic drug monitoring did not reveal any clinically significant drug-drug interactions. Despite virological response, the patient remained severely decompensated and re-transplantation was performed after 46 days of undetectable serum HCV RNA. The patient is doing well 12 months after his second liver transplantation and remains free of hepatitis C virus.
  
  
  CONCLUSIONS
  The use of directly acting antivirals may allow for successful liver re-transplantation for recipients who remain decompensated despite virological response and is likely to improve the outcome of liver re-transplantation for end-stage recurrent hepatitis C.
authors.affiliation: Service of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland. Julien.Vionnet@chuv.ch.|Transplantation Center, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland. Julien.Vionnet@chuv.ch.|Service of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland. Julien.Vionnet@chuv.ch.
authors.forename: Julien
authors.initials: J
authors.lastname: Vionnet
authors.affiliation: Transplantation Center, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland. Manuel.Pascual@chuv.ch.
authors.forename: Manuel
authors.initials: M
authors.lastname: Pascual
authors.affiliation: Laboratory and Division of Clinical Pharmacology, Service of Biomedicine, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland. Haithem.Chtioui@chuv.ch.
authors.forename: Haithem
authors.initials: H
authors.lastname: Chtioui
authors.affiliation: Service of Gastroenterology and Hepatology, Geneva University Hospitals, Geneva, Switzerland. Emiliano.Giostra@hcuge.ch.
authors.forename: Emiliano
authors.initials: E
authors.lastname: Giostra
authors.affiliation: Services of Transplant and Abdominal Surgery, Geneva University Hospitals, Geneva, Switzerland. Pietro.Majno@hcuge.ch.
authors.forename: Pietro E
authors.initials: PE
authors.lastname: Majno
authors.affiliation: Laboratory and Division of Clinical Pharmacology, Service of Biomedicine, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland. LaurentArthur.Decosterd@chuv.ch.
authors.forename: Laurent A
authors.initials: LA
authors.lastname: Decosterd
authors.affiliation: Service of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland. Darius.Moradpour@chuv.ch.
authors.forename: Darius
authors.initials: D
authors.lastname: Moradpour
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D006084:Graft Rejection / Q000188:drug therapy*; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000517:prevention & control; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012008:Recurrence; D012086:Reoperation; D012254:Ribavirin / Q000627:therapeutic use*; D000069474:Sofosbuvir / Q000627:therapeutic use*
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin; D000069474:Sofosbuvir