title: Successful Anti-HCV Therapy of a Former Intravenous Drug User with Sofosbuvir and Daclatasvir in a Peritranspant Setting: A Case Report.
abstract: BACKGROUND Direct-acting antivirals (DAAs) represent a new hallmark in antiviral therapy of hepatitis C virus (HCV). DAAs have been shown to be safe and effective after liver transplantation (LT), but there is little information about their use in peritransplant settings. Former intravenous drug users represent an increasing group seeking HCV treatment. This case report demonstrates the successful peritransplant antiviral treatment of a former intravenous drug user who had been treated in a methadone maintenance program. CASE REPORT The patient was diagnosed with Child B cirrhosis for the first time in 2009. He had a Model for End-stage Liver Disease (MELD) score of 21 and started antiviral therapy with sofosbuvir (SOF) and daclatasvir (DCV) in March 2014. Due to hepatic decompensation, he received a LT in April 2014. Immunosuppression was performed with tacrolimus (TAC) and mycophenolate-mofetil (MMF), and boosted with prednisolone in the initial stage. Four weeks after his LT, the patient presented with an acute renal injury. The patient was discharged one week later after sufficient hydration, discontinuation of non-steroidal anti-phlogistics therapy, and adjustments to his immunosuppressive regimen. At the beginning of his therapy, the number of RNA copies was 13,000 IU/mL. He received 24 weeks of anti-HCV treatment with SOF and DCV; the antiviral treatment was successful and his LT was well tolerated.  CONCLUSIONS Treatment of HCV is feasible in a peritransplant setting. The antiviral regimen we used did not seem to have any relevant interactions with the patient's immunosuppressive regimens. Still, the peritransplant setting is a very demanding environment for anti-HCV therapy, and further studies are needed.
authors.affiliation: Department of Transplantation Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Leon Louis
authors.initials: LL
authors.lastname: Seifert
authors.affiliation: Department of Transplantation Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Hauke
authors.initials: H
authors.lastname: Heinzow
authors.affiliation: Department of Transplantation Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Iyad
authors.initials: I
authors.lastname: Kabar
authors.affiliation: , Center for Interdisciplinary Medicine (CIM) Infectious Diseases, Münster, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Christensen
authors.affiliation: Department of Transplantation Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Hüsing
authors.affiliation: Department of Transplantation Medicine, University Hospital Münster, Münster, Germany.
authors.forename: Hartmut H-J
authors.initials: HH
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D002219:Carbamates; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use*; D016031:Liver Transplantation; D008297:Male; D019990:Perioperative Care; D011759:Pyrrolidines; D000069474:Sofosbuvir / Q000627:therapeutic use*; D015819:Substance Abuse, Intravenous; D014633:Valine / Q000031:analogs & derivatives
chemical_list: D000998:Antiviral Agents; D002219:Carbamates; D007093:Imidazoles; D011759:Pyrrolidines; D014633:Valine; C549273:daclatasvir; D000069474:Sofosbuvir