IFN-Based and IFN-Free Direct-Acting Antiviral Drug Treatments for Acquired Hepatitis C Virus in Post-Transplant Recipients

Background: Hepatitis C virus (HCV) infection frequently occurs in recipients of liver or kidney transplants (LT/KT). Interferon (IFN)-based therapies are used to treat HCV, but their efficacy is low. Methods: We report 24 patients who received HCV therapy after LT/KT.Design, Setting, and Participants-Twelve LT and 12 KT recipients (median age, 59 years; 15 males; 21 serological type 1) were enrolled, of whom eight (six with LT) were treated with IFN-based therapy. Twelve received direct-acting antiviral drugs [DAAs; daclatasvir (DCV)/asunaprevir (ASV) therapy] for 24 weeks, seven received sofosbuvir (SOF)/ledipasvir (LDV) for 12 weeks, and one received SOF/ribavirin for 12 weeks.Results: In two LT patients, HCV resolved spontaneously after LT. Six patients received IFN, of whom one achieved a sustained virological response for 24 or more weeks (SVR) (16.7%), three cases stopped treatment due to side effects (anemia and infection), and two cases relapsed. Five received DCV/ASV, and four received SOF-based DAA, including those with IFN failure. All patients completed treatment with a SVR. Two KT cases were treated with IFN; one was successfully treated and one discontinued treatment due to renal rejection. All cases, including the one IFN failure, achieved a SVR after DAA therapy. Two who received DCV/ASV showed a low estimated glomerular filtration rate (eGFR), and three who received SOF/LDV contained the NS5A mutation. HCV treatment by DAAs was successful in all patients.Conclusions: DAAs were highly effective and safe in LT/KT recipients who failed IFN-based therapy and had a low eGFR or the NS5A mutation.