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Effectiveness of Ledipasvir/Sofosbuvir with/without Ribavarin in Liver Transplant Recipients with Hepatitis C

  • Sammy Saab*,1,2,
  • Justin Rheem3,
  • Melissa A. Jimenez2,
  • Tiffany M. Fong2,
  • Michelle H. Mai2,
  • Caterina A. Kachadoorian2,
  • Negin L. Esmailzadeh2,
  • Sherona N. Bau1,2,
  • Susan Kang1,2,
  • Samantha D. Ramirez2,
  • Jonathan Grotts4,
  • Gina Choi1,2,
  • Francisco A. Durazo1,2,
  • Mohammed M. El-Kabany1,2,
  • Steven-Huy B. Han1,2 and
  • Ronald W. Busuttil1,2
 Author information
Journal of Clinical and Translational Hepatology   2017;5(2):101-108

doi: 10.14218/JCTH.2016.00070


Background and Aims: Recurrent infection of hepatitis C virus (HCV) in liver transplant (LT) recipients is universal and associated with significant morbidity and mortality.

Methods: We retrospectively evaluated the safety and efficacy of ledipasvir/sofosbuvir with and without ribavirin in LT recipients with recurrent genotype 1 hepatitis C.

Results: Eighty-five LT recipients were treated for recurrent HCV with ledipasvir/sofosbuvirwith and without ribavirin for 12 or 24 weeks. The mean (± standard deviation [SD]) time from LT to treatment initiation was 68 (±71) months. The mean (± SD) age of the cohort was 63 (±8.6) years old. Most recipients were male (70%). Baseline alanine transaminase, total bilirubin, and HCV ribonucleic acid (RNA) values (± SD) were 76.8 (±126) mg/dL, 0.8 (±1.3) U/L, and 8,010,421.9 (±12,420,985) IU/mL, respectively. Five of 43 recipients who were treated with ribavirin required drug cessation due to side effects, with 4 of those being anemia complications. No recipient discontinued the ledipasvir/sofosbuvir. Eighty-one percent of recipients had undetectable viral levels at 4 weeks after starting therapy, and all recipients had complete viral suppression at the end of therapy. The sustained viral response at 12 weeks after completion of therapy was 94%.

Conclusion: Ledipasvir and sofosbuvir with and without ribavirin therapy is an effective and well-tolerated interferon-free treatment for recurrent HCV infection after LT. Anemia is not uncommon in LT recipients receiving ribavirin.


Liver transplantation, Immunosuppressant, Hepatitis C, Direct-acting agents, Sustained viral response


Hepatitis C virus (HCV) is the leading indication for liver transplantation (LT) in the United States.1 Post-LT recipients universally develop recurrent HCV infection. Recipients with HCV have 30% higher mortality at 5 years and can develop aggressive recurrent disease.2–4 Whereas 20% of infected patients in the general population develop cirrhosis after 2 decades, a similar percentage of transplant recipients develop cirrhosis after just 5 years.4–6

HCV treatment of LT recipients has substantially evolved over the past several decades. Due to the significant side effects associated with treatment, HCV therapy was initially limited to patients at risk of progressive liver disease. However, recent advances in treatment have lowered the treatment threshold, particularly among LT recipients.7–10 Given that the sustained viral response (SVR) in the general population is similar to that in the transplant community, transplant recipients are no longer considered to be a difficult to treat population.11–13

A number of all-oral antiviral therapies have been used to treat recurrent HCV in LT recipients. These regimens differ by their treatment duration, need for ribavirin, and potential drug interaction.14–35 Furthermore, antiviral treatment in LT recipients has been found to be cost effective.36 The purpose of this study was to determine the efficacy of ledipasvir and sofosbuvir with or without ribavirin (LDV/SOF ± RBV) in a non-clinical trial setting. The hypothesis of our study was that LDV/SOF ± RBV is safe and effective in LT recipients.


We performed a retrospective chart review of all adult LT recipients who had been treated with LDV/SOF at the University of California Los Angeles Medical Center (UCLA) between September 2014 and June 2016.

Inclusion criteria included age of at least 18 years at the beginning of treatment, diagnosis of genotype 1 HCV infection, and detectable HCV ribonucleic acid (RNA) after LT. Quantitative PCR was used to detect the HCV RNA viral load. A polymerase chain reaction was used to amplify the viral target RNA followed by hybridization for HCV genotyping. Exclusion criteria included evidence of allograft rejection on biopsy within 6 months of starting the antiviral therapy and critical illness (i.e. patients with circulatory shock, respiratory failure, and acute renal failure requiring urgent dialysis) at start of therapy.

Data were obtained by review of medical records and review of the UCLA LT database after Institutional Review Board approval. Demographic data (age, sex), HCV genotype, history of LT, history of previous HCV therapy, non-liver related medical history (active cardiopulmonary disease, hemodialysis, stroke, non-liver malignancy, diabetes), co-existent liver disease (non-alcoholic fatty liver disease [NAFLD], hepatitis B infection, autoimmune hepatitis, hepatocellular carcinoma [HCC]), and immunosuppressant regimen were recorded. The presence and severity of liver fibrosis was assessed using imaging, blood work and histology. Fibrosis-4 (FIB-4) scores were used to determine cirrhosis in patients without imaging and biopsy.

Transplant recipients were treated with LDV 90 mg and SOF 400 mg in a fixed-dosed combination tablet once daily with or without ribavirin (600 mg per day) for 12 weeks or 24 weeks. Recipients were preferably treated for 24 weeks if they had baseline or treatment-related anemia. Anemia was defined as hemoglobin < 12 g/dL. SVR was defined as an undetectable HCV value at 12 weeks after treatment completion (SVR12). The SVR was calculated on an intent-to-treat basis. The goal therapeutic range for tacrolimus was 6–10 ng/mL and for cyclosporine was 100–200 ng/mL.

A set of hematologic data, biochemical data, and HCV RNA levels were collected at initiation of treatment, 4 weeks after initiation of treatment (4W), end of therapy (EOT), and 12 weeks after treatment completion. Continuous variables were presented as mean [±standard deviation (SD)], and categorical variables were expressed as percentage. A mixed effects model using random intercepts by recipient was used in STATA 13 (College Station, TX, USA) to evaluate the changes in hematologic and biochemical data at the above defined time periods. A p-value of 0.05 or less in regression coefficients or in pairwise comparisons between time points was considered statistically significant.


Baseline characteristics

We identified 85 consecutive LT recipients who were treated for HCV genotype 1 using LDV/SOF ± RBV (Table 1). Eighty-two of the recipients (96.5%) had undergone only one LT, and three were treated after their second or third LT. Seven recipients had undergone simultaneous liver-kidney transplantation. Most recipients were men, and the overall mean (± SD) age was 63.1 (± 8.6) years. Forty-six patients (54.1%) were treatment-naïve. Eighteen patients were treatment-experienced before orthotopic (O)LT, and 21 after OLT. Most had been treated prior with an interferon-based antiviral regimen (69.2%). Most patients were on tacrolimus based immunosuppressant regimen (88.2%).

Table 1.

Patient demographics

Number of Patients85
Age in years, mean ± SD63.1 ± 8.6
Male, n (mean ± SD %)57 (70.0 ± 47.3 %)
Medical history, n (%)
 Active cardiopulmonary disease9 (10.6%)
 Hemodialysis10 (11.8%)
 Stroke7 (8.2%)
 Recent non-HCC malignancy within 5 years9 (10.6%)
 Diabetes27 (31.8%)
 Lymphoma1 (1.2%)
Co-existent liver disease(s), n (%)
 Non-alcoholic fatty liver disease (NAFLD)1 (1.2%)
 Hepatitis B3 (3.9%)
 Autoimmune hepatitis1 (1.2%)
 Hepatocellular carcinoma40 (47.1%)
Mean time from LT to Treatment Initiation in months (±SD)68.3 (±70.6)
Received more than one LT3 (3.5%)
Treatment-naïve, n (%)46 (54.1%)
Treatment-experienced, n (%)39 (45.9%)
 Treatment prior to LT18 (46.2%)
  Interferon/ribavirin15 (83.3%)
  Sofosbuvir/ribavirin1 (5.6%)
  Sofosbuvir/simeprevir2 (11.1%)
 Treatment post-LT21 (53.8%)
  Interferon/ribavirin10 (47.6%)
  Sofosbuvir/interferon/ribavirin2 (9.5%)
  Sofosbuvir/ribavirin4 (19.0%)
  Sofosbuvir/simeprevir ± ribavirin4 (19.0%)
  Ribavirin monotherapy1 (4.8%)
Stage of fibrosis at start of treatment, n (%)
 0–133 (38.8%)
 2–318 (21.2%)
 434 (40%)
Presence of fibrosing cholestatic hepatitis1 (1.2%)
Immunosuppression therapy, n (%)
 Tacrolimus only30 (35.3%)
 Tacrolimus + mycophenolate ± prednisone39 (45.9%)
 Tacrolimus + sirolimus ± prednisone6 (7.1%)
 Cyclosporine only3 (3.5%)
 Cyclosporine + mycophenolate4 (4.7%)
 Sirolimus + mycophenolate2 (2.4%)
 Sirolimus + prednisone1 (1.2%)
Treatment regimen, n (%)
 Sofosbuvir/ledipasvir for 12 weeks18 (21.2%)
 Sofosbuvir/ledipasvir + ribavirin for 12 weeks33 (38.8%)
 Sofosbuvir/ledipasvir for 24 weeks29 (34.1%)
 Sofosbuvir/ledipasvir + ribavirin for 24 weeks5 (5.9%)

The mean (±SD) time from transplantation to treatment initiation with LDV/SOF based therapy was 68.3 (±70.6) months. Forty-eight (57%), including a recipient with fibrosing cholestatic hepatitis, had a liver biopsy before starting antiviral therapy. Almost half the LT recipients had a diagnosis of cirrhosis (n = 34, 40%) prior to treatment initiation. The diagnosis of HCC was the indication for LT in 37 (37/40) of the recipients. A diagnosis of HCC was made incidentally at the time of surgery in 3 (3/40) of the recipients. Out of the 10 (11.8%) recipients on dialysis, 6 (60%) were treated with LDV/SOF without ribavirin. Twenty (74.1%) of the recipients with baseline anemia were treated with LDV/SOF without ribavirin. Baseline laboratory values are shown in Table 2.

Table 2.

Mean (and standard deviation) of laboratory values

Laboratory testBaseline4 WeeksEOTSVR12Pt Diffp-Value*
Platelet count (×1000 cells/μL)143.4 ± 59.1160.1 ± 65.6159.9 ± 76.1152.6 ± 67.59.2 (9.2)0.054
Albumin (g/dL)4.1 ± 1.24.1 ± 0.44.1 ± 0.44.1 ± 0.50 (0)0.822
AST (U/L)62.4 ± 79.525.0 ± 13.925.6 ± 20.328.2 ± 22.3−34.3 (−34.3)<0.001
ALT (U/L)76.8 ± 12625.2 ± 19.224.6 ± 21.727.6 ± 24.5−49.3 (−49.3)0.001
Total bilirubin (mg/dL)0.8 ± 1.30.9 ± 0.70.9 ± 1.20.7 ± 0.9−0.1 (−0.1)0.453
Serum creatinine (mg/dL)1.3 ± 0.41.3 ± 0.41.3 ± 0.41.3 ± 0.40 (0)0.514
Alkaline phosphatase (U/L)129.5 ± 175.3111.4 ± 176.799.6 ± 53.6124.2 ± 134.7−5.3 (−5.3)0.694
Hemoglobin (g/dL)12.8 ± 1.711.9 ± 2.312.0 ± 2.113.2 ± 1.80.3 (0.3)0.033
 In patients with RBV therapy13.2 ± 1.311.5 ± 2.112.0 ± 1.713.4 ± 1.60.2 (0.2)0.477
 In patients without RBV therapy12.5 ± 2.012.3 ± 2.512.1 ± 2.513.0 ± 2.00.5 (0.5)0.017

Fifty-one recipients were started on LDV/SOF ± RBV with a goal duration of 12 weeks, and treatment was extended in 4 recipients due to detectable HCV viral levels at week 4 of treatment (Fig. 1). All 4 of these recipients were also being treated with ribavirin. Thirty-four patients of the entire cohort of 85 recipients received LDV/SOF ± RBV with a goal duration of 24 weeks. No interruptions in antiviral therapy occurred in any of the recipients.

Patient disposition.
Fig. 1.  Patient disposition.

Abbreviations: LDV, ledipasvir; SOF, sofosbuvir; RBV, ribavirin; SVR, sustained viral response.

Biochemical and HCV RNA viral response

From baseline to 12 weeks post-treatment, there was a statistically significant decrease in the alanine transaminase (ALT) and total bilirubin levels. The mean (±SD) ALT value decreased from 76.8 (± 126) IU/L to 27.6 (± 24.5) IU/L (p = 0.001). The mean (±SD) baseline serum HCV RNA was 8,010,421.9 IU/mL (±12,420,985) (Table 2). Eighty-one of the 85 recipients had their viral load measured at 4 weeks of treatment. HCV RNA was undetectable in 65 recipients, detectable but unquantifiable in 5 recipients, and quantifiable in 11 recipients. The viral load was undetectable in all patients at the end of treatment. Eighty (94.1%) recipients achieved SVR 12 (Table 4, Fig. 2). Thirty-one of the 34 (91.2%) patients with cirrhosis achieved SVR12 with antiviral therapy. Forty-nine of 51 (96.1%) patients without cirrhosis achieved SVR12. Thirty-eight of the HCC recipients achieved SVR12 (95%). The two patients that did not achieve SVR had HCC as an indication for LT. The SVR12 in recipients without a diagnosis of HCC was 93%. There was no statistically significant difference in SVR12 between cirrhotic and non-cirrhotic patients (p = 0.385) and between HCC and non-HCC recipients (p = 1).

Overall viral kinetics.
Fig. 2.  Overall viral kinetics.

Abbreviation: SVR, sustained viral response.

Five recipients experienced viral relapse. Viral relapse occurred in all recipients within 4 weeks of completing antiviral therapy. Four recipients were retreated and achieved SVR12 with alternative treatment regimens (Table 3). The fifth recipient expired due to primary lung cancer. Resistance associated mutations were assessed after viral relapse with LDV/SOF. Their characteristics and outcomes are shown in Table 3.

Table 3.

Characteristics and outcomes of recipients who relapsed

IDAge/SexGTPrior treatmentRAMFibrosis stageTreatment regimenLT to treatment TimeImmunosuppressantOutcome
657/M1a/1bSOF/SIM × 12 wNS5A ∼ Q30Q/H/K/N
NS3/4A ∼ Q80K
3LDV/SOF/RBV × 12 w24 MonthsTacrolimus, SirolimusDeceased (Lung Cancer)
959/M1aNaïveNS5A ∼ None
NS3/4A ∼ V55A
2LDV/SOF × 12 w60 MonthsTacrolimusSVR12 with LDV/SOF/RBV × 24 w
5963/M1bSOF/RBV × 24 wNS5A ∼ Y93H
NS3/4A ∼ None
2LDV/SOF/RBV × 24 w108 MonthsTacrolimusRetreated and relapsed on SOF/SIM/RBV.
8253/M1aSOF/RBV × 24 wNS5A ∼ None
NS3/4A ∼ None
4LDV/SOF × 24 w8 MonthsTacrolimus, MycophenolateSVR12 with SOF/RBV/EBR/GZR
8865/M1aSOF/RBV × 24 wNS5A ∼ L31, H58P
NS3/4A ∼ Q80K
2LDV/SOF/RBV × 12 w114 MonthsTacrolimusSVR12 with SOF/SIM/RBV × 24 w

There was a statistically significant change in the distribution of fibrosis stage as determined by FIB-4 scores, between the start of treatment and SVR12 (p < 0.001) (Fig. 3). The number of recipients with stage 0-1 at baseline and SVR12 was 7 (8%) and 21 (25%), respectively. The number of recipients with cirrhosis at baseline and SVR12 was 32 (38%) and 20 (24%), respectively.

Fibrosis-4 score at baseline and SVR12.
Fig. 3.  Fibrosis-4 score at baseline and SVR12.

Abbreviations: FIB-4, fibrosis-4 score; SVR, sustained viral response.


Anemia was the most common safety issue in our cohort treated with LDV/SOF with ribavirin. Five of the 43 recipients required ribavirin cessation and their treatment with LDV/SOF monotherapy was extended for a total treatment duration of 24 weeks. Anemia occurred within 4 weeks of starting therapy in 4 of the recipients. One patient discontinued ribavirin because of potential anemia given underling chronic kidney disease (stage II) and his advanced age. However, the patient did not develop anemia during ribavirin therapy. All the recipients who developed anemia were 64 years of age or older. No transplant recipient required erythropoietin-stimulating agents or a blood transfusion. No transplant recipients discontinued LDV/SOF for adverse effects.


The results of our study highlight the efficacy, safety and tolerability of LDV/SOF in LT recipients. The SVR12 in our cohort was 94%, and no patient developed adverse side-effects related to LDV/SOF. In contrast, the use of ribavirin, even at non-weight based dosing, was associated with significant anemia in 4 of 43 ribavirin recipients. None of the patients in our cohort required admission, erythropoietin-stimulating agents, or a blood transfusion.

The results of our study add to the increasing body of literature supporting the role of direct-acting agents (DAAs) in LT recipients. Potentially, LT recipients may represent a cohort of patients in which HCV may be completely eliminated. Indeed, the combined guidance position paper by the American Association for the Study of Liver Diseases (commonly known as AASLD) and Infectious Diseases Society of America (commonly known as IDSA) places LT recipients at the highest priority for antiviral therapy.10 Until recently, liver biopsies were routinely performed in LT recipients since interferon–based therapy was associated with substantial adverse effects. Today, multiple antiviral regimens are available with comparable SVR12 (Table 4). There are important differences among the strategies, such as need for ribavirin, duration of treatment, and potential drug interactions. Furthermore, some DAAs are contraindicated in decompensated liver disease and in patients with compromised renal function.37–40

Table 4.

Summary of major trials evaluating direct-acting agents for recurrent HCV infection in post-liver transplants

AuthorRefGenotypeTherapyDuration in weeksnSVR
Charlton et al.141, 3, 4SOF/RBV244070% (55–73%)*
Forns et al.151–4SOF/RBV24–489259% (43–73%)
Charlton et al.161, 4LDV/SOF/RBV1211692% (60–100%)††
2411395% (75–100%)††
Manns et al.171LDV/SOF/RBV1210095% (50–100%)††
249998% (80–100%)††
Elfeki et al.181LDV/SOF1232100%
Kwok et al.191LDV/SOF8786%
Omichi et al.201LDV/SOF1818100%
Saab et al.211SOF/SIM123093%
Khemichian et al.221SOF/SIM123294%
Pungpapong et al.231SOF/SIM/RBV1210590%
Gutierrez et al.241SOF/SIM/RBV126193%
Punzalan et al.251SOF/SIM124295%
Crittenden et al.261SOF/SIM/RBV125688%
Brown et al.271SOF/SIM/RBV1215188%
Jackson et al.281SOF/SIM126788%
Kwo et al.291OBV/DSV/PTV/r243497%
Flisiak et al.301, 4OBV/DSV/PTV/r2421100%
Poordad et al.311SOF/DCV/RBV124195%
Leroy et al.321, 4SOF/RBV12888%
1, 3, 4SOF/DCV1215100%
Coilly et al.331–5SOF/DCV±RBV12, 2413796% (75–100%)**
Dumortier et al.341–5SOF/DCV/RBV12–2412593% (92–94%)††
Welzel et al.351–5SOF/DCV/RBV248594% (92–100%)*

Treatment of HCV in LT recipients is an evolving field. When we started utilizing DAAs in transplant recipients, there were no DAA regimens approved for patients with advanced kidney disease. Recently, two regiments were approved by the Federal Drug Administration in patients undergoing hemodialysis: a) dasabuvir plus ombitasvir, paritaprevir, and ritonavir; and b) elbasvir and grazoprevir. However, there is a paucity of experience using elbasvir and grazoprevir in LT recipients and there are substantial drug interactions with dasabuvir plus ombitasvir, paritaprevir, and ritonavir which limit current use.41 In our early experience, we decided to proceed with sofosbuvir-based regimens, even in patients on hemodialysis if we felt the benefits outweighed the risks. Indeed, 10 recipients on our study were on dialysis. The decision to proceed with treating patients on hemodialysis was based on earlier experience.42

An important area of discussion is the timing of antiviral therapy.43 The efficacy of antiviral therapy is well established in LT recipients. An important caveat is that relatively early treatment is preferable since some strategies appear to have a drop off in SVR12 with increasing amount of liver damage.16 In particular, outcomes are significantly better when initiated early in the course of fibrosing cholestatic hepatitis.32,44 Another option is to treat patients before LT. Many providers have based their views on the experience of hepatitis B virus therapy in patients with advanced disease who had remarkable improvement in liver function with viral suppression.45–47 In fact, data from a recent publication suggests that liver function may stabilize provided that the model of end-Stage liver disease (commonly known as MELD) is less than 15 and select patients may indeed be removed from the transplant list.48 On the other hand, renal insufficiency, inability to use HCV-positive grafts, lower SVR in patients with advanced liver disease, and possible viral resistance with relapse are several factors that may temper widespread enthusiasm for treating patients before LT.49

Our study has a number of limitations. First, the cohort is from a single center and may not be generalizable to other institutions. Nevertheless, we treated consecutive patients who represent the spectrum of LT recipients with cirrhosis and are treatment experienced. Another limitation is the lack of a control group. We do not feel the absence of a control group is a serious detriment to our study particularly given the lack of noticeable adverse effects that impact drop out from the study. Larger studies may uncover unfavorable side effects not identified in this study. Another limitation of our study is the heterogeneity of our drug regimens. Most of the time, the final drug regimen was determined after discussion with health care providers since recipients were often treated before the official guidance on LT recipients was published. On the other hand, the results of the study represent an early real-life experience with LDV/SOF.

The results of our single center, non-clinical trial, real world experience demonstrate the safety, efficacy, and tolerability of LDV/SOF with and without ribavirin in post-LT patients. This combination of DAAs should be considered in LT recipients with recurrent HCV who are candidates for antiviral therapy. Further studies are needed to compare the utility of LDV/SOF with other non-interferon based therapies.



liver transplant


hepatitis C virus


sustained viral response


















paritaprevir with ritonavir


model for end-stage liver disease


non-alcoholic fatty liver disease


hepatocellular carcinoma


end of therapy


standard deviation


orthotopic liver transplant


aspartate transaminase


alanine transaminase


direct-acting antivirals


international normalized ratio


ribonucleic acid


fibrosis-4 score


Conflict of interest

The authors have no conflict of interests related to this publication.

Authors’ contributions

Study design (SS, JR, MAJ), performance of experiments/acquisition of data (TMF, MHM, CAK, NLE), analysis and interpretation of data (SS, JR, MAJ, SNB, SK), manuscript writing (SS, JR, MAJ), critical revision (SS, GC, FAD, MME, SBH, RWB), statistical analysis (JG).


  1. Kim WR, Lake JR, Smith JM, Skeans MA, Schladt DP, Edwards EB. OPTN/SRTR 2013 Annual Data Report: liver. Am J Transplant 2015;15:1-28 View Article
  2. Ghobrial RM, Steadman R, Gornbein J, Lassman C, Holt CD, Chen P. A 10-year experience of liver transplantation for hepatitis C: analysis of factors determining outcome in over 500 patients. Ann Surg 2001;234:384-393 View Article
  3. Prieto M, Berenguer M, Rayón JM, Córdoba J, Argüello L, Carrasco D. High incidence of allograft cirrhosis in hepatitis C virus genotype 1b infection following transplantation: relationship with rejection episodes. Hepatology 1999;29:250-256 View Article
  4. Forman LM, Lewis JD, Berlin JA, Feldman HI, Lucey MR. The association between hepatitis C infection and survival after orthotopic liver transplantation. Gastroenterology 2002;122:889-896 View Article
  5. Saab S, Wang V. Recurrent hepatitis C following liver transplant: diagnosis, natural history, and therapeutic options. J Clin Gastroenterol 2003;37:155-163 View Article
  6. Firpi RJ, Clark V, Soldevila-Pico C, Morelli G, Cabrera R, Levy C. The natural history of hepatitis C cirrhosis after liver transplantation. Liver Transpl 2009;15:1063-1071 View Article
  7. Saab S, Kalmaz D, Gajjar NA, Hiatt J, Durazo F, Han S. Outcomes of acute rejection after interferon therapy in liver transplant recipients. Liver Transpl 2004;10:859-867 View Article
  8. Saab S, Oh MK, Ibrahim AB, Durazo F, Han S, Yersiz H. Anemia in liver transplant recipients undergoing antiviral treatment for recurrent hepatitis C. Liver Transpl 2007;13:1032-1038 View Article
  9. Berenguer M. Systematic review of the treatment of established recurrent hepatitis C with pegylated interferon in combination with ribavirin. J Hepatol 2008;49:274-287 View Article
  10. AASLD-IDSA. HCV guidance: recommendations for testing, managing, and treating hepatitis C. Available from: http://www.hcvguidelines.org , accessed September 1, 2016
  11. Bunchorntavakul C, Tanwandee T. Treatment of chronic hepatitis C in special populations. Gastroenterol Clin North Am 2015;44:883-900 View Article
  12. Kwo PY. Direct acting antiviral therapy after liver transplantation. Curr Opin Gastroenterol 2016;32:152-158 View Article
  13. Bonacci M, Lens S, Mariño Z, Forns X. Challenges in special populations: HIV/HCV coinfection, liver transplantation and patients with end-stage renal disease. Dig Dis 2016;34:317-326 View Article
  14. Charlton M, Gane E, Manns MP, Brown RS, Curry MP, Kwo PY. Sofosbuvir and ribavirin for treatment of compensated recurrent hepatitis C virus infection after liver transplantation. Gastroenterology 2015;148:108-117 View Article
  15. Forns X, Charlton M, Denning J, McHutchison JG, Symonds WT, Brainard D. Sofosbuvir compassionate use program for patients with severe recurrent hepatitis C after liver transplantation. Hepatology 2015;61:1485-1494 View Article
  16. Charlton M, Everson GT, Flamm SL, Kumar P, Landis C, Brown RS. Ledipasvir and sofosbuvir plus ribavirin for treatment of HCV infection in patients with advanced liver disease. Gastroenterology 2015;149:649-659 View Article
  17. Manns M, Samuel D, Gane EJ, Mutimer D, McCaughan G, Buti M. Ledipasvir and sofosbuvir plus ribavirin in patients with genotype 1 or 4 hepatitis C virus infection and advanced liver disease: a multicentre, open-label, randomised, phase 2 trial. Lancet Infect Dis 2016;16:685-697 View Article
  18. Elfeki M, Abou Mrad R, Modaresi Esfeh J, Zein N, Eghtesad B, Zervos X. Sofosbuvir/ledipasvir without ribavirin achieved high sustained virologic response for hepatitis C recurrence after liver transplantation: two-center experience. Transplantation 2017;101:996-1000 View Article
  19. Kwok RM, Ahn J, Schiano TD, Te HS, Potosky DR, Tierney A. Sofosbuvir plus ledispasvir for recurrent hepatitis C in liver transplant recipients. Liver Transpl 2016;22:1536-1543 View Article
  20. Omichi K, Akamatsu N, Mori K, Togashi J, Arita J, Kaneko J. Asunaprevir/daclatasvir and sofosbuvir/ledipasvir for recurrent hepatitis C following living donor liver transplantation. Hepatol Res 2016 View Article
  21. Saab S, Greenberg A, Li E, Bau SN, Durazo F, El-Kabany M. Sofosbuvir and simeprevir is effective for recurrent hepatitis C in liver transplant recipients. Liver Int 2015;35:2442-2447 View Article
  22. Khemichian S, Lee B, Kahn J, Noureddin M, Kim B, Harper T. Sofosbuvir and simeprevir therapy for recurrent hepatitis C infection after liver transplantation. Transplant Direct 2015;1:e21 View Article
  23. Pungpapong S, Aqel B, Leise M, Werner KT, Murphy JL, Henry TM. Multicenter experience using simeprevir and sofosbuvir with or without ribavirin to treat hepatitis C genotype 1 after liver transplant. Hepatology 2015;61:1880-1886 View Article
  24. Gutierrez JA, Carrion AF, Avalos D, O’Brien C, Martin P, Bhamidimarri KR. Sofosbuvir and simeprevir for treatment of hepatitis C virus infection in liver transplant recipients. Liver Transpl 2015;21:823-830 View Article
  25. Punzalan CS, Barry C, Zacharias I, Rodrigues J, Mehta S, Bozorgzadeh A. Sofosbuvir plus simeprevir treatment of recurrent genotype 1 hepatitis C after liver transplant. Clin Transplant 2015;29:1105-1111 View Article
  26. Crittenden NE, Buchanan LA, Pinkston CM, Cave B, Barve A, Marsano L. Simeprevir and sofosbuvir with or without ribavirin to treat recurrent genotype 1 hepatitis C virus infection after orthotopic liver transplantation. Liver Transpl 2016;22:635-643 View Article
  27. Brown RS, O’Leary JG, Reddy KR, Kuo A, Morelli GJ, Burton JR. Interferon-free therapy for genotype 1 hepatitis C in liver transplant recipients: Real-world experience from the hepatitis C therapeutic registry and research network. Liver Transpl 2016;22:24-33 View Article
  28. Jackson WE, Hanouneh M, Apfel T, Alkhouri N, John BV, Zervos X. Sofosbuvir and simeprevir without ribavirin effectively treat hepatitis C virus genotype 1 infection after liver transplantation in a two-center experience. Clin Transplant 2016;30:709-713 View Article
  29. Kwo PY, Mantry PS, Coakley E, Te HS, Vargas HE, Brown R. An interferon-free antiviral regimen for HCV after liver transplantation. N Engl J Med 2014;371:2375-2382 View Article
  30. Flisiak R, Janczewska E, Wawrzynowicz-Syczewska M, Jaroszewicz J, Zarębska-Michaluk D, Nazzal K. Real-world effectiveness and safety of ombitasvir/paritaprevir/ritonavir ± dasabuvir ± ribavirin in hepatitis C: AMBER study. Aliment Pharmacol Ther 2016;44:946-956 View Article
  31. Poordad F, Schiff ER, Vierling JM, Landis C, Fontana RJ, Yang R. Daclatasvir with sofosbuvir and ribavirin for hepatitis C virus infection with advanced cirrhosis or post-liver transplantation recurrence. Hepatology 2016;63:1493-1505 View Article
  32. Leroy V, Dumortier J, Coilly A, Sebagh M, Fougerou-Leurent C, Radenne S. Efficacy of sofosbuvir and daclatasvir in patients with fibrosing cholestatic hepatitis C after liver transplantation. Clin Gastroenterol Hepatol 2015;13:1993-2001.e1-2 View Article
  33. Coilly A, Fougerou-Leurent C, de Ledinghen V, Houssel-Debry P, Duvoux C, Di Martino V. Multicentre experience using daclatasvir and sofosbuvir to treat hepatitis C recurrence - The ANRS CUPILT study. J Hepatol 2016;65:711-718 View Article
  34. Dumortier J, Leroy V, Duvoux C, de Ledinghen V, Francoz C, Houssel-Debry P. Sofosbuvir-based treatment of hepatitis C with severe fibrosis (METAVIR F3/F4) after liver transplantation. Liver Transpl 2016;22:1367-1378 View Article
  35. Welzel TM, Petersen J, Herzer K, Ferenci P, Gschwantler M, Wedemeyer H. Daclatasvir plus sofosbuvir, with or without ribavirin, achieved high sustained virological response rates in patients with HCV infection and advanced liver disease in a real-world cohort. Gut 2016;65:1861-1870 View Article
  36. Saab S, Gonzalez YS, Huber C, Wang A, Juday T. Cost-effectiveness of ombitasvir/paritaprevir/ritonavir, dasabuvir+ribavirin for US post-liver transplant recurrent genotype 1 HCV. Liver Int 2016;36:515-521 View Article
  37. Cacoub P, Desbois AC, Isnard-Bagnis C, Rocatello D, Ferri C. Hepatitis C virus infection and chronic kidney disease: Time for reappraisal. J Hepatol 2016;65:S82-S94 View Article
  38. ZEPATIER (elbasvir and grazoprevir). Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/208261Orig1s000lbl.pdf , accessed January 2016
  39. VIEKIRA PAK (ombitasvir, paritaprevir, and ritonavir tablets; dasabuvir tablets). Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/206619lbl.pdf , accessed December 2014
  40. HARVONI® (ledipasvir and sofosbuvir). Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/205834s010lbl.pdf , accessed June 2016
  41. Gane EJ, Agarwal K. Directly acting antivirals (DAAs) for the treatment of chronic hepatitis C virus infection in liver transplant patients: “a flood of opportunity”. Am J Transplant 2014;14:994-1002 View Article
  42. Saab S, A Jimenez M, N Bau S, Choi G, Durazo FA, M El-Kabany M. Use of sofosbuvir-based treatment of chronic hepatitis C in liver transplant recipients on hemodialysis. J Clin Gastroenterol 2017;51:167-173 View Article
  43. Suraweera D, Saab EG, Tong MJ, Saab S. Timing of hepatitis C antiviral therapy in liver transplant recipients with direct-acting agents. Exp Clin Transplant 2016 View Article
  44. Saab S, Jimenez M, Bau S, Goo T, Zhao D, Durazo F. Treating fibrosing cholestatic hepatitis C with sofosbuvir and ribavirin: a matched analysis. Clin Transplant 2015;29:813-819 View Article
  45. Yao FY, Terrault NA, Freise C, Maslow L, Bass NM. Lamivudine treatment is beneficial in patients with severely decompensated cirrhosis and actively replicating hepatitis B infection awaiting liver transplantation: a comparative study using a matched, untreated cohort. Hepatology 2001;34:411-416 View Article
  46. Hann HW, Fontana RJ, Wright T, Everson G, Baker A, Schiff ER. A United States compassionate use study of lamivudine treatment in nontransplantation candidates with decompensated hepatitis B virus-related cirrhosis. Liver Transpl 2003;9:49-56 View Article
  47. Liaw YF, Sung JJ, Chow WC, Farrell G, Lee CZ, Yuen H. Lamivudine for patients with chronic hepatitis B and advanced liver disease. N Engl J Med 2004;351:1521-1531 View Article
  48. Belli LS, Berenguer M, Cortesi PA, Strazzabosco M, Rockenschaub SR, Martini S. Delisting of liver transplant candidates with chronic hepatitis C after viral eradication: A European study. J Hepatol 2016;65:524-531 View Article
  49. Suraweera D, Sundaram V, Saab S. Treatment of Hepatitis C Virus Infection in Liver Transplant Recipients. Gastroenterol Hepatol (N Y) 2016;12:23-30
  • Journal of Clinical and Translational Hepatology
  • pISSN 2225-0719
  • eISSN 2310-8819
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Effectiveness of Ledipasvir/Sofosbuvir with/without Ribavarin in Liver Transplant Recipients with Hepatitis C

Sammy Saab, Justin Rheem, Melissa A. Jimenez, Tiffany M. Fong, Michelle H. Mai, Caterina A. Kachadoorian, Negin L. Esmailzadeh, Sherona N. Bau, Susan Kang, Samantha D. Ramirez, Jonathan Grotts, Gina Choi, Francisco A. Durazo, Mohammed M. El-Kabany, Steven-Huy B. Han, Ronald W. Busuttil
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