title: Use of Sofosbuvir-Based Treatment of Chronic Hepatitis C in Liver Transplant Recipients on Hemodialysis.
abstract: BACKGROUND
  The use of direct acting agents has changed the management paradigm of hepatitis C (HCV) in liver transplant (LT) recipients. However, the appropriate antiviral regimen in LT recipients on hemodialysis (HD) remains unclear.
  
  
  METHODS
  We retrospectively evaluated the safety and efficacy of sofosbuvir-based LT recipients on HD followed at the University of California Los Angeles.
  
  
  RESULTS
  Twelve LT recipients on HD were treated for recurrent HCV with sofosbuvir-based therapy. Indications for antiviral therapy included fibrosing cholestatic hepatitis, symptomatic cryoglobulinemia, and recurrent HCV. The causes of renal failure included hepatorenal syndrome, acute tubular necrosis and cryoglobulinemia. Of those who were not on dialysis at the time of transplantation, the mean creatinine (±SD) was 1.7 (±0.8) mg/dL. The mean age (±SD) of the cohort was 62.2 (±6.0) years. Most recipients were male (67%) and infected with genotype 1 (83%). Baseline alanine aminotransferase, total bilirubin, hemoglobin and HCV RNA values (±SD) were 53.2 (±59.4) IU/L, 3.2 (±5.5) mg/dL, 10.5 (±1.8) g/dL, and 30,499,500 (±29,655,754) IU/mL. HCV RNA levels were undetectable in all recipients at the end of therapy. The trough mean (±SD) hemoglobin of patients on treatment and on HD was 8.4 (±2.3). The sustained viral response was 58% (7/12), and the overall patient survival was 42%. All the deaths occurred a mean (±SD) after 5.4 (±3.6) months after treatment was completed.
  
  
  CONCLUSIONS
  All patients achieved viral suppression from therapy, and over half the recipients achieved a sustained virological response. A high mortality underscores the necessity of starting antiviral treatment sooner in LT recipients and the need for larger cohort studies.
authors.affiliation: Departments of *Surgery †Medicine, University of California at Los Angeles, Los Angeles, CA.
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.forename: Melissa
authors.initials: M
authors.lastname: A Jimenez
authors.forename: Sherona
authors.initials: S
authors.lastname: N Bau
authors.forename: Gina
authors.initials: G
authors.lastname: Choi
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Durazo
authors.forename: Mohammed
authors.initials: M
authors.lastname: M El-Kabany
authors.forename: Steven-Huy B
authors.initials: SB
authors.lastname: Han
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Busuttil
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy* / Q000821:virology; D006435:Renal Dialysis / Q000379:methods; D012189:Retrospective Studies; D000069474:Sofosbuvir / Q000627:therapeutic use*; D000072230:Sustained Virologic Response
chemical_list: D000998:Antiviral Agents; D000069474:Sofosbuvir