Gastroenterology & Hepatology: Open Access Multidisciplinary Approach to treat Liver Transplant Recipients with Hepatitis C using Sofosbuvir based Therapy Submit Manuscript | http://medcraveonline.com Volume 7 Issue 1 - 2017 1 Department of Transplant Pharmacy, The Ohio State University-Wexner Medical Center, USA 2 Department of Surgery, The Ohio State University-Wexner Medical Center, USA 3 Center for Biostatistics, The Ohio State University-Wexner Medical Center, USA 4 Department of Medicine, The Ohio State University-Wexner Medical Center, USA *Corresponding author: Khalid Mumtaz, Assistant Professor, Division of Gastroenterology, Hepatology & Nutrition, Wexner Medical Center, The Ohio State University, Columbus, OH, 43210, USA, Tel: 614-685-8657; Email: Received: June 13, 2017 | Published: June 28, 2017 Research Article Gastroenterol Hepatol Open Access 2017, 7(1): 00227 Abstract Introduction: The safety and efficacy of the direct acting antivirals in liver transplant recipients is unknown. Materials and Methods: Retrospective cohort study on 44 liver transplant recipients, ≥18 years old who received Sofosbuvir (SOF) based antiviral therapy (AVT) at our hospital from January 2012 through May 2016. Multidisciplinary (MDT) approach involving hepatologists, transplant pharmacists and a patient access coordinator was adapted. SVR at 12 and 24 weeks, safety and compliance of SOF based AVT were reported. We also reported on improvement in APRI and CPT score at SVR. Results: 35 patients (79.5%) were treated with Ledipasvir (LDV) /SOF, 7 (16 %) with SOF/RBV and 2 (4.5%) with SOF/Simeprevir (SIM). Most patients were HCV genotype 1 (n=37; 84.1%) and treatment experienced (n= 24; 55%). Median time between liver transplant (LT) and AVT was 2.7 years with majority (66%) treated ≥ 12 months after LT. Median pre-treatment HCV viremia was 3,800,000 (71,000-66,000,000) with a high viral load ≥ 800,000 copies/ml in 36 (82%) patients. SVR 12 and 24 were achieved in 43/44 (98%), despite a low (77.3%) rapid virological response. Statistically significant improvement was observed in pre-treatment and post- SVR median albumin levels, APRI and CPT scores. Fatigue (27%) was the most commonly reported adverse effect. Compliance rate was 100%. Conclusion: With a MDT approach, using SOF based AVT, a very high SVR was achieved in liver transplant recipients with recurrent HCV infection. A MDT approach positively impacts medication acquisition, enhances patient education and compliance in post LT HCV management. Keywords: Multidisciplinary; HCV; Liver transplantation; Antiviral therapy; Direct antiviral agents; Sofosbuvir Abbreviations: SOF: Sofosbuvir; AVT: Antiviral Therapy; MDT: Multidisciplinary Team; LDV: Ledipasvir; SIM: Simeprevir; HCV: Hepatitis C Virus; LT: Liver Transplantation; IS: Immunosuppressive; SVR: Sustained Virological Response; GT: Genotype; DAA: Direct Acting Antiviral; CPT: Child-Pugh-Turcotte; TP: Transplant Pharmacist; PAC: Patient Access Coordinator; AASLD: American Association for the Study of Liver Diseases; RBV: Ribavirin; APRI: AST to Platelet Ratio Index; LTRs: Liver Transplant Recipients Introduction Hepatitis C virus (HCV) presents a major health care challenge and is the leading indication for liver transplantation (LT) in the United States [1,2]. Recurrence of HCV after LT is universal and contributes immensely to graft failure and early mortality due to immunosuppressive (IS) therapy related acceleration of fibrosis [3]. Treatment with AVT and eradication of virus is the only way to improve the outcomes related to recurrence of HCV. Until 2011, pegylated interferon plus ribavirin was the standard of care for HCV treatment, resulting in a sustained virological response (SVR) in around 30%-50% of transplant recipients with HCV genotype 1(GT) [4-11]. A major change in paradigm has been observed with the discovery of safe and effective direct acting antiviral (DAA) therapy in the field of HCV treatment [12]. These DAAs have already been shown to change the landscape of AVT for HCV infection in non-transplant and post LT settings. Recently published randomized controlled studies on the use of sofosbuvir based AVT reported SVR rates ranging between 70% to 85% in post LT patients with child-pugh-turcotte (CTP) A, B and C patients [4,13,14]. Overall, the treatment was well tolerated, with few severe side effects. Similar results were reported in studies based on real world data such as TRIO and TARGET 2.0 trials [15-18]. A recent real world data-based study published from Canada on efficacy of SOF-based treatment reported overall SVR rates of 85% in all genotypes [19]. However, these results are not as encouraging as reported in non-transplant setting with SVR of ~95% [20-22]. Besides HCV genotype, and stage of fibrosis, compliance to therapy is a very important predictive factor of SVR [23]. Post LT patients are on multiple medications besides