title: Prevention of hepatitis C recurrence by bridging sofosbuvir/ribavirin from pre- to post-liver transplant: a real-life strategy.
abstract: Hepatitis C virus (HCV) re-infection following liver transplant (LT) is associated with reduced graft and patient survival. Before transplant, Sofosbuvir/Ribavirin (SOF/R) treatment prevents recurrent HCV in 96% of those patients achieving viral suppression for at least 4 weeks before transplant. We evaluated whether a bridging SOF-regimen from pre- to post-transplant is safe and effective to prevent HCV recurrence in those patients with less than 4 weeks of HCV-RNA undetectability at the time of transplant.
  
  
  
  From July 2014 SOF/R was given in 233 waitlisted HCV cirrhotics with/without hepatocellular carcinoma (HCC) within an Italian Compassionate Program. One hundred patients were transplanted and 31 patients (31%) treated with SOF/R bridging therapy were studied.
  
  
  
  Liver transplant indication in bridge subgroup was HCC in 22 and decompensated cirrhosis in 9. HCV-genotype was 1/4 in 18 patients. SOF 400 mg/day and R (median dosage 800 mg/day) were given for a median of 35 days before LT. At transplant time, 19 patients were still HCV-RNA positive (median HCV-RNA 58 IU/mL). One recipient had a virological breakthrough at week 4 post-transplant; one died, on treatment, 1-month post-transplant for sepsis and 29/31 achieved a 12-week sustained virological response (94%). Acute cellular rejection occurred in three recipients. On September 2016, 30 recipients (97%) were alive with a median follow-up of 18 months (range 13-25).
  
  
  
  In patients with suboptimal virological response at LT, a bridging SOF/R regimen helps avoiding post-transplant graft reinfection.
authors.affiliation: Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
authors.forename: Maria Francesca
authors.initials: MF
authors.lastname: Donato
authors.affiliation: U.O. Medicina Interna e delle Insufficienze d'Organo-Azienda Ospedaliera-Universitaria, Policlinico S. Orsola-Malpighi di Bologna, Bologna, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Morelli
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
authors.affiliation: Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Invernizzi
authors.affiliation: Hepatology Unit and Liver Transplantation Surgery, Niguarda Hospital, Milan, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Mazzarelli
authors.affiliation: Liver and Multivisceral Transplant Center, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.
authors.forename: Rosa Maria
authors.initials: RM
authors.lastname: Iemmolo
authors.affiliation: Infectious Diseases and General Surgery, National Institute for Infectious Diseases Spallanzani, Rome, Italy.
authors.forename: Marzia
authors.initials: M
authors.lastname: Montalbano
authors.affiliation: Gastroenterology Unit and Experimental Medicine and Surgery, University of Tor Vergata, Rome, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Lenci
authors.affiliation: Surgery and Liver Transplantation Unit, IRCCS National Institute of Cancer, Milan, Italy.
authors.forename: Sherrie
authors.initials: S
authors.lastname: Bhoori
authors.affiliation: Division of Hepatology, IRCCS AO San Martino IST, Genova, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Pieri
authors.affiliation: U.O. Medicina Interna e delle Insufficienze d'Organo-Azienda Ospedaliera-Universitaria, Policlinico S. Orsola-Malpighi di Bologna, Bologna, Italy.
authors.forename: Sonia
authors.initials: S
authors.lastname: Berardi
authors.affiliation: Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Caraceni
authors.affiliation: Liver Transplantation Center, Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Martini
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000628:therapy; D004359:Drug Therapy, Combination; D005260:Female; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000188:drug therapy* / Q000517:prevention & control; D006801:Humans; D007558:Italy; D008103:Liver Cirrhosis / Q000628:therapy; D008113:Liver Neoplasms / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D057234:Preoperative Period; D012008:Recurrence; D012189:Retrospective Studies; D012254:Ribavirin / Q000009:adverse effects / Q000627:therapeutic use*; D000069474:Sofosbuvir / Q000009:adverse effects / Q000627:therapeutic use*; D000072230:Sustained Virologic Response
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin; D000069474:Sofosbuvir
keywords: hepatitis C; hepatocellular carcinoma; liver transplant; sofosbuvir therapy; virological response