Miami, Florida — New data offers hope to liver transplant patients infected with the hepatitis C virus. This virus may lead to liver destruction and cancer in up to 40% of the 5 million Americans infected with the virus. The only cure is liver transplantation for the end-stage form of hep C, but after this life saving procedure the liver damage occurs rapidly again in the new liver. Half of patients who undergo a transplant may need another one within 5 years because of the return of the virus.
New therapies for hepatitis C, such as sofosbuvir (Sovaldi) and simeprevir (Olysio), have been shown to be highly effective before transplant, but have not been studied after liver transplant. There are several concerns but at the forefront are doubts the medications against hep C will not be as efficient in patients on the potent immunosuppressant essential to maintain a solid organ transplant.
Researchers from the Miami Transplant Institute explored this question and presented high cure rates using the combination of sofosbuvir and simeprevir for 12 weeks in patients after liver transplant. The authors showed an overall 93.4% cure rate (sustained virologic response 12 [SVR 12]) in this study. The most common form of hepatitis C in the United States is known as genotype 1. In this study, patients with genotype 1b had a 100% cure rate. Those who failed treatment had more advanced liver disease and genotype 1a.
Lead author, Dr. Julio Gutierrez of the Texas Liver Institute and the University of Texas Health Science Center San Antonio, commented “The potency of direct-acting antiviral do not appear to be contingent on an intact immune system, and the results of our study are comparable to what was presented in the recent COSMOS trial.” Dr. Gutierrez is referring to the 2014 Lancet COSMOS trial that showed a cure rate of 92-94% in non-transplant patients using the same medications.
Dr. Adam Peyton, the corresponding author, echoed the enthusiasm for the results of the trial, “We need to be more aggressive in eradicating hepatitis C in this patient population (post-liver transplant). The administration of the combination of sofosbuvir and simeprevir was safe in this patient population, and no significant drug-drug interactions were seen.” Use of the older hepatitis C drugs, such as telaprevir, caused havoc on the drugs used for immunosuppression.
For additional details, see http://onlinelibrary.wiley.com/doi/10.1002/lt.24126/abstract