Impact of Early Initiation of Direct-Acting Antiviral Therapy in Thoracic Organ Transplantation From Hepatitis C Virus Positive Donors

Systematic review: hepatitis C viraemic allografts to hepatitis C‐negative recipients in solid organ transplantation

“…There were no reports of graft failure. One recipient died of a pulmonary embolism in the Smith et al study 39 . There were no complications of HCV infection reported (Table 1).…”

“…Our initial search terms resulted in a set of 2186 articles, of which 35 studies satisfied the inclusion and exclusion criteria (Figure 1), 13‐46 including one paper identified with reference search 47 . There were 852 SOTs, which included 343 kidney, 233 heart, 204 liver and 72 lung transplants.…”

“… 25 A total of 12 deaths occurred. Five deaths were from primary graft failure, one death from graft dysfunction, 45 one from a pulmonary embolism, 26 one from disseminated bacteremia, 27 one from heart failure, 22 two deaths from necrotizing pancreatitis 39,46 and one death from multi‐organ failure with antibody‐mediated rejection 24 . None of the causes of death was reported to be specifically related to or associated with HCV transmission.…”

“…Two of these studies—one observational and one non‐randomized clinical trial—implemented prophylactic DAA treatment with 52 total recipients of HCV viraemic allografts 27,39 . Median follow‐up was approximately 9 months for both studies.…”

Hepatitis C viraemic organs in solid organ transplantation

“…However, this strategy has several potential barriers, including (1) payor approval of therapy prior to documented HCV transmission; (2) interruptions in therapy for patients requiring prolonged ventilation, however, in the largest, real-world prospective cohort this led to delay in initiation of therapy for median of 72 days for kidney recipients, 51 days for liver recipients, and 103 days for heart recipients with 2 cases of fibrosing cholestatic hepatitis due to HCV at 11 and 14 weeks posttransplant 35 . Given nearly 100% SVR 12 with regimens that are started post-transplant and given for 12 or more weeks and the high number of patients who required re-treatment with a second line DAA in the short prophylaxis regimens, our practice is to wait until patients become viremic post-transplant and treat for full 12 week course with regimen based on genotype and resistance testing, recognizing that the preliminary data with prophylactic strategy and of shorter duration (4-8 weeks) with G/P and SOF/VEL is promising 24,28,29,32,33,[36][37][38] .…”