title: Safety, Efficacy, and Tolerability of Sofosbuvir and Ribavirin in Management of Recurrent Hepatitis C Virus Genotype 4 After Living Donor Liver Transplant in Egypt: What Have We Learned so far?
abstract: BACKGROUND
  Recurrence of HCV after living donor liver transplant (LDLT) is nearly universal, with almost one third of recipients developing cirrhosis and graft failure within 5 years after LDLT. Different studies have been published on the effect of sofosbuvir after liver transplantation on recurrent HCV with different genotypes.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the efficacy, safety, and tolerability of sofosbuvir and ribavirin in LDLT recipients with recurrent HCV genotype 4.
  
  
  METHODS
  Thirty-nine Egyptian LDLT recipients were treated for recurrent HCV after LDLT with nucleos(t)ide analog NS5B polymerase inhibitor, sofosbuvir, and ribavirin without pegylated interferon for 6 months (November 2014 to June 2015) in this intention-to-treat analysis.
  
  
  RESULTS
  One recipient died 1 week after starting the treatment, but the remaining 38 patients completed 24 weeks of treatment and were then followed for 12 weeks after end of treatment (EOT). The sustained virological response (SVR) at week 12 after EOT was achieved in 76% (29/38) of recipients. SVR was significantly higher in treatment-naïve patients and in recipients with a low stage of fibrosis. Only 2 (5%) recipients developed severe pancytopenia and acute kidney injury.
  
  
  CONCLUSIONS
  We recommend initiating treatment as soon as possible after liver transplantation with newer combinations, such as ledipasvir/sofosbuvir or sofosbuvir/simeprevir, rather than sofosbuvir with Ribavirin, to achieve higher rates of SVR.
authors.affiliation: Ain Shams Center for Organ Transplant, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Hany M
authors.initials: HM
authors.lastname: Dabbous
authors.affiliation: Ain Shams Center for Organ Transplant, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Iman F
authors.initials: IF
authors.lastname: Montasser
authors.affiliation: Ain Shams Center for Organ Transplant, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Sakr
authors.affiliation: Ain Shams Center for Organ Transplant, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Rasha
authors.initials: R
authors.lastname: Refai
authors.affiliation: Ain Shams Center for Organ Transplant, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Moataz
authors.initials: M
authors.lastname: Sayam
authors.affiliation: Ain Shams Center for Organ Transplant, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdelmonem
authors.affiliation: Ain Shams Center for Organ Transplant, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Hany
authors.initials: H
authors.lastname: Sayed
authors.affiliation: Ain Shams Center for Organ Transplant, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: F Abdelghafar
authors.affiliation: Ain Shams Center for Organ Transplant, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Bahaa
authors.affiliation: Ain Shams Center for Organ Transplant, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: S Elmeteini
keywords: Genotype 4; Liver Transplant; Sofosbuvir