Treatment of HCV and decompensated liver disease after transplantation

There are no prospective clinical trial data that specifically evaluate the efficacy of treatment with sofosbuvir plus velpatasvir with or without ribavirin for post-transplant HCV in people with decompensated cirrhosis and HCV Gt 2, 3, 5 or 6.

We recommend treatment with the regimens used for people with decompensated liver disease before liver transplantation (Table 5). The clinical benefit of achieving SVR in patients with decompensated liver disease due to recurrent HCV after liver transplantation was shown in a multicentre, prospective study of 52 patients with Gt 1 or 4 HCV who were treated with sofosbuvir plus ledipasvir plus ribavirin for 12 versus 24 weeks (SOLAR-1).[70] (Ledipasvir is an older genotype-specific NS5A inhibitor that is no longer marketed in Australia.) The ribavirin starting dose was 600 mg; increased dosing on-treatment was rare. SVR was observed in 85%–88% of patients (45/52) with Child–Pugh B cirrhosis and 60%–75% (6/9) with Child–Pugh C cirrhosis. Response rates were similar with 12 and 24 weeks of treatment. No study has examined a ribavirin-free regimen in post-transplant patients