Outcomes of the Treatment with Glecaprevir/Pibrentasvir following heart transplantation utilizing hepatitis C viremic donors

Abstract

Background: The use of direct-acting antivirals (DAA) has expanded transplantation from hepatitis C viremic donors (HCV-VIR). Our team has conducted an open-label, prospective trial to assess outcomes transplanting HCV viremic hearts. Glecaprevir/ pibrentasvir (GLE/PIB) was our sole DAA. Methods: Serial quantitative hepatitis C virus (HCV) RNA PCR was obtained to as

Pancreas transplantation from hepatitis C viremic donors to uninfected recipients

“…Previous studies have demonstrated the safety of heart, lung, liver, and kidney transplantation from HCV viremic donors into HCV-naïve recipients treated with DAA therapy immediately after transplant. [8][9][10][11][12][13][14][15] Although these are mostly small series, these studies have shown While not statistically significant, the HCV D+/R-cohort had a higher KDPI compared to the HCV D-/R-cohort (42% vs. 23%, p = .07). Notably, HCV status is incorporated in the KDPI calculation, and the KDPI for a HCV-positive donor is approximately 20% higher than a kidney from an otherwise identical HCV-negative donor.…”

“…Studies of heart, lung, liver, and kidney HCV D+/R-transplants have all demonstrated excellent patient outcomes with 100% sustained virologic response (SVR) following DAA treatment. [8][9][10][11][12][13][14][15] A recent study of short-course DAA therapy for 30 HCV D+/R-solid organ transplants included one pancreas-kidney recipient but did not provide granular information on the recipient outcomes or extended follow-up. 16 Pancreas transplantation is most often performed in the setting of type 1 diabetes with end-stage renal disease, either as a deceased donor simultaneous pancreas-kidney transplant (SPK) or after living donor kidney transplant (PAK).…”

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

“…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.…”

Hepatitis C viraemic organs in solid organ transplantation

“…9/11 (85%) developed detectable HCV viremia post-transplant and were started on SOF/ledipasvir (LDV) for 12 weeks (genotype 1) or SOF/VEL for 12-24 weeks (genotype 3) as an outpatient at a median 33 days posttransplant with 100% SVR12. Following this study, several other centers reported their own experiences with similar strategies 22,[26][27][28]35,36 . In total, this included 165 HCV-nonviremic recipients who received viremic hearts followed by surveillance NAT and treatment with J o u r n a l P r e -p r o o f various DAA regimens if positive.…”

“…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] .…”