Reply to "The choice of antiviral therapy for hepatitis C recurrence after liver transplantation in the real world"

Letter to the Editor

Reply to “The choice of antiviral therapy

for hepatitis C recurrence after liver

transplantation in the real world”

etiol-ogies for liver transplantation. The recurrence of HCV is universal after liver transplantation. Because of post-transplantation immunosuppression, profound viral repli-cation and rapid fibrosis progression in the engrafted liver could be anticipated if left untreated.1

Indeed, six (50%) of the patients in our treatment cohort have possessed advanced liver fibrosis, and three (25%) grafts have developed compensated liver cirrhosis at the time of initiating direct-acting antivirals (DAAs). Ideally, interferon-free DAAs should be commenced between 1 and 3 months post-transplant.2However, the major obstacle in the treatment of chronic hepatitis C is no longer the choice of regimes. Rather, the major concern and huddle is the restrained resources from the care providers.3_{The current}

study depicted the result of a paritaprevir/ritonavir/ ombitasvir plus dasabuvir (PrOD) named-patient program for compassionate use upon the special population in 2015 when Taiwanese patients have no any other treatment choice supported by the national reimbursement.4 Not until 2018 did HCV genotype 1 post-liver transplant patients have access to the first DAA, sofosbuvir/ledipasvir, pro-vided by the National Health Insurance Administration of Taiwan. We demonstrated the satisfactory results of the real world experience of PrOD, in particular among patients with advanced liver disease. Although there are substantial drugedrug interactions between PrOD and immunosup-pressive agents, all are manageable. Imperatively, thanks to the compassionate program, at least three-year gap of rapid fibrosis progression was saved on the engrafted liver of the twelve patients who rebirthed from liver transplantation.

Conflict of interest

Appendix A. Supplementary data

Supplementary data to this article can be found online at

https://doi.org/10.1016/j.jfma.2018.09.014.

References

1. Lin TY, Yeh ML, Huang CI, Chen YL, Dai CY, Huang JF, et al. Pegylated interferon plus ribavirin combination therapy in postliver transplant recipients with recurrent hepatitis C virus infection. Kaohsiung J Med Sci 2017;33(6):284e9.

2. Omata M, Kanda T, Wei L, Yu ML, Chuang WL, Ibrahim A, et al. APASL consensus statements and recommendation on treatment of hepatitis C. Hepatol Int 2016;10(5):702e26.

3. Yu ML. Hepatitis C treatment from “response-guided” to “resource-guided” therapy in the transition era from interferon-containing to interferon-free regimens. J Gastroenterol Hepatol 2017;32(8):1436e42.

4. Yu ML, Chen YL, Huang CF, Lin KH, Yeh ML, Huang CI, et al. Par-itaprevir/ritonavir/ombitasvir plus dasabuvir with ribavirin for treatment of recurrent chronic hepatitis C genotype 1 infection after liver transplantation: real-world experience. J Formos Med Assoc 2018;117:518e26.

Ming-Lung Yu*

Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan Available online atwww.sciencedirect.com

ScienceDirect

journal home page:www.jfma-onl ine.com Journal of the Formosan Medical Association (2018)117, 1038e1039

https://doi.org/10.1016/j.jfma.2018.09.014

0929-6646/Copyrightª 2018, Formosan Medical Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan Institute of Biomedical Sciences, National Sun Yat-Sen University, Taiwan College of Biological Science and Technology, National Chiao Tung University, Hsin-Chu, Taiwan

*Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. E-mail address:fishya@ms14.hinet.net