Introduction
Recurrent HCV infection after transplantation is aggressive, and progression to cirrhosis is more rapid than in non-transplant settings. As pegylated interferon (Peg-IFN) based therapies for HCV treatment after transplantation have poor tolerance, poor efficacy, and significant interactions with immunosuppression medications, this developed the need for a new safe and effective oral regimen.

Aim
To evaluate the efficacy, safety and tolerability of sofosbuvir (SOF) in combination with ribavirin (RBV) in treating recurrent hepatitis C after transplantation and also to detect any significant interaction with immunosuppressive therapy

Patients and methods
Between August 2014 and January 2016, a single center, prospective, non-randomized, open labeled study was conducted, in which the patients with post-transplant recurrent HCV infection were enrolled. All patients received 400 mg once-daily SOF for 24 weeks with variable dose of RBV. After treatment, patients underwent follow up for 12 weeks.

Results
Sixty patients were enrolled, mean age was 57.67 years with 78.3% were male. 70% had genotype 1 and 61.7% received previous HCV treatment. At baseline, 21 patients had severe fibrosis. Median time interval from LT was 51 months, immunosuppressive therapy was tacrolimus based in 78.3%. Median baseline HCV-RNA was 2.341.172 IU/ml. 12-week SVR was achieved in 43 patients (71.7%). There was no significant difference in dose and level of tacrolimus during course of therapy. Absence of HE, treatment-naive patients, non-severe fibrosis and low pre-therapy LS values were predictors for SVR.
Conclusion
IFN free regimen containing SOF and RBV is generally safe, well tolerated and reasonably effective in post-transplantation settings