Acute severe recurrence of hepatitis C virus (HCV) after solid organ transplant is associated with high mortality. Pegylated interferon and ribavirin are suboptimal in treatment of this severe form of recurrence. We report 4 cases of acute severe HCV recurrence (within 6 months after transplant), including 3 cases with fibrosing cholestatic hepatitis treated with sofosbuvir and ribavirin. All four patients achieved a rapid suppression of HCV RNA with a normalization of liver function tests within 4 weeks of starting therapy. All patients were HCV RNA negative at 12 weeks after stopping therapy. The combination was found to be safe as anemia was the only adverse effect, which developed in 2 patients (1 patient required blood transfusion, while another managed with erythropoietin). Sofosbuvir and ribavirin appear to be safe and efficacious in treatment of acute severe HCV recurrence after organ transplant.
Keywords: ALT, alanine aminotransferase; AST, aspartate aminotransferase; DAA's, sofosbuvir; FCH, fibrosing cholestatic hepatitis; Fibrosing cholestatic hepatitis; GGTP, gamma glutamyl transpeptidase; HCV, hepatitis C virus; IHBR, intrahepatic biliary radicals; Kidney transplant; LFT, liver function tests; LRLT, living-related liver transplant; Liver transplant; MMF, mycophenolate mofetil; MRCP, magnetic resonance cholangiopancreatography; POD, postoperative day; TND, target not detected.