title: Impact of viral eradication with sofosbuvir-based therapy on the outcome of post-transplant hepatitis C with severe fibrosis.
abstract: Several studies have shown that new direct-acting antivirals maintain their efficacy in liver transplant (LT) recipients with severe hepatitis C virus (HCV) recurrence. We determined the clinical impact of sofosbuvir/ribavirin in LT through the changes in liver function and fibrosis state at 24 and 48 weeks after treatment.
  
  
  
  Between June 2014 and July 2015, 126 patients (30 F3, 96 F4 Metavir stage) were enrolled to receive sofosbuvir + ribavirin (24 weeks, 118 patients) or sofosbuvir + simeprevir + ribavirin (12 weeks, 8 patients); treatment was initiated at a median time of 4.3 years from LT. Median follow-up after therapy completion was 461 days.
  
  
  
  All 30 F3 patients achieved a sustained virological response at week 24 after treatment (SVR24) and showed a distinct amelioration of the AST-to-platelet ratio index (APRI), FIB-4 and liver stiffness at elastography by week 24 post-therapy, which were maintained at week 48. Of the 96 F4 cirrhotic patients, 72 (75%) achieved SVR24 accompanied by significant improvement of liver function, which was maintained at week 48 (Child B-C 22% baseline, 11% week 24, 7% week 48); APRI, FIB-4 and liver stiffness further improved significantly between weeks 24 and 48 of follow-up. Among the 77 responders (27 F3, 50 F4) who underwent elastography at baseline and at the end of follow-up, 39 (50.6%; 18 F3, 21 F4) exhibited a regression in fibrosis stage.
  
  
  
  At about 1 year from the completion of successful sofosbuvir-based therapy, patients with post-LT HCV and severe fibrosis experienced a long-term liver function improvement accompanied by a regression of fibrosis stage in half of them.
authors.affiliation: Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Martini
authors.affiliation: Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Sacco
authors.affiliation: Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Strona
authors.affiliation: Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Arese
authors.affiliation: Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Tandoi
authors.affiliation: Regional Transplantation Center, Piedmont, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
authors.forename: Dominic
authors.initials: D
authors.lastname: Dell Olio
authors.affiliation: Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Stradella
authors.affiliation: Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
authors.forename: Donatella
authors.initials: D
authors.lastname: Cocchis
authors.affiliation: Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Mirabella
authors.affiliation: Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Rizza
authors.affiliation: Regional Transplantation Center, Piedmont, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Magistroni
authors.affiliation: Regional Transplantation Center, Piedmont, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
authors.forename: Pamela
authors.initials: P
authors.lastname: Moschini
authors.affiliation: Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ottobrelli
authors.affiliation: Regional Transplantation Center, Piedmont, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Amoroso
authors.affiliation: Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzetto
authors.affiliation: Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Salizzoni
authors.affiliation: Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
authors.forename: Giorgio M
authors.initials: GM
authors.lastname: Saracco
authors.affiliation: Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
authors.forename: Renato
authors.identifier: 0000-0001-8340-8885
authors.initials: R
authors.lastname: Romagnoli
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D054459:Elasticity Imaging Techniques; D005260:Female; D005838:Genotype; D016174:Hepacivirus; D006526:Hepatitis C / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D007558:Italy; D008103:Liver Cirrhosis / Q000473:pathology* / Q000821:virology; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012254:Ribavirin / Q000627:therapeutic use; D000069616:Simeprevir / Q000627:therapeutic use; D000069474:Sofosbuvir / Q000627:therapeutic use*; D000072230:Sustained Virologic Response
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin; D000069616:Simeprevir; D000069474:Sofosbuvir
keywords: HCV recurrence; direct-acting antivirals; liver transplantation; non-invasive fibrosis tests; survival