Therapy With Direct-Acting Antiviral Agents for Hepatitis C in Liver Transplant Recipients

Garrido, Aurelio; Suazo, Eva Julissa Ortega; Calles, Francisco Vadillo; López, Ferran Campillo i; Aguilar, M.D. Espinosa

doi:10.1016/j.transproceed.2017.09.057

Cited by 6 publications

(4 citation statements)

References 7 publications

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“…Historically, up to 88% of HCV+ liver transplant recipients suffered from recurrent disease due to persistent viremia, and 20% developed cirrhosis due to HCV recurrence. 33-39 Although debate remains over whether DAA therapy should be administered before or after liver transplantation for HCV+ recipients, DAA therapy is highly effective at achieving SVR regardless of timing, supporting our finding that HCV+ female recipients, who historically were more prone to developing HCV disease recurrence, are no longer at increased risk for graft loss in the modern DAA era. 40,41…”

Section: Discussionsupporting

confidence: 74%

Are Hepatitis C Positive Female Liver Transplant Recipients Still at Increased Risk for Graft Failure? Reexamining the Disparity in the Modern Era of Direct-acting Antiviral Agents

et al. 2021

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Original Clinical Science-LiverBackground. This study aimed to compare the outcomes of hepatitis C virus (HCV) positive (+) female liver transplant recipients to HCV negative (-) female and HCV+ male recipients before and after the direct-acting-antiviral (DAA) era. Methods. The United Network for Organ Sharing liver transplant database was retrospectively reviewed from 2002 to 2017. The DAA era was defined as ≥2014. Results. In the pre-DAA era, HCV+ female recipients had greater risk for graft failure compared with HCV+ male (hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.01-1.11; P = 0.03) and HCVfemale (HR, 1.51; 95% CI, 1.43-1.60; P < 0.001) recipients. In the post-DAA era, HCV+ female recipients had lower risk for graft failure compared with HCV+ male recipients (HR, 0.82; 95% CI, 0.70-0.97; P = 0.02) and equivalent outcomes to HCV-female recipients. HCV+ female recipients with graft failure had increased likelihood of graft failure due to disease recurrence compared with HCV+ male recipients in the pre-DAA era (odds ratio, 1.23; 95% CI, 1.08-1.39; P = 0.001) but not in the post-DAA era. Conclusions. Although historically HCV+ female recipients were at disproportionately increased risk for graft failure and disease recurrence, this disparity has been eliminated in the DAA era.

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Section: Discussionsupporting

confidence: 74%

Are Hepatitis C Positive Female Liver Transplant Recipients Still at Increased Risk for Graft Failure? Reexamining the Disparity in the Modern Era of Direct-acting Antiviral Agents

et al. 2021

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“…Only the latter patient relapsed again, 12 weeks after the end of therapy. These data are slightly inferior to those obtained in different studies (9,10). Biochemical parameters showed an improvement in 12 weeks after therapy in patients with SVR even though only AST and ALT decreases were statistically significant ( Table 2).…”

Section: Resultscontrasting

confidence: 64%

Therapy with Direct-Acting Antiviral Agents in Transplanted Patients with HCV Recurrence: A Retrospective Analysis

et al. 2019

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The recurrence of HCV infection after liver transplantation was the main cause of mortality and loss of graft in transplanted patients until the use of direct-acting antivirals (DAAs). We performed a monocentric retrospective study from November 2014 to September 2017 at "Ospedali Riuniti", Ancona, Italy, to evaluate the outcome and tolerability of DAAs after liver transplantation. In total, 55 patients with HCV recurrence after liver transplantation treated with DAAs were included. The most frequent genotype was genotype 1a (36%), followed by genotype 3a (27%). The majority of the patients presented a mild or moderate hepatic fibrosis (METAVIR score of F0 -F1 in 20% and F2 in 27%). The patients received sofosbuvir + daclatasvir, sofosbuvir + ribavirin, sofosbuvir + simeprevir, sofosbuvir + ledipasvir, and sofosbuvir + velpatasvir in 54%, 18%, 13%, 13%, and 2% of the cases, respectively, for 12 or 24 weeks. The SVR 12 rate was 89% overall, without a statistically significant relationship with genotypes, fibrosis stage, and therapy. Moreover, 52% of the patients modified the dosage of tacrolimus in the first three months of therapy with DAAs, without statistical significance compared to the group that not changed tacrolimus dosage. The most frequent adverse events were anemia associated with ribavirin. IFN-free treatment with DAAs is highly effective for HCV relapse after liver transplantation and it showed high tolerability in our patients.

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“…This, therefore, eliminates the risk of recurrence of hepatitis C in the graft. Additionally, when necessary, DAA can be used safely after transplantation, with little risk of graft rejection and high efficacy, unlike earlier IFN-based treatments[ 105 , 136 ]. This efficacy and safety have been confirmed in recipients of other solid organ transplants, such as kidney transplant patients with chronic hepatitis C[ 137 ], thereby endorsing their use in the transplant population.…”

Section: Hepatitis Cmentioning

confidence: 99%

Present and future management of viral hepatitis

Grande¹,

Leiva²,

Ortega³

et al. 2021

WJG

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Viral hepatitis can result in important morbidity and mortality, with its impact on health conditioned by the specific type of hepatitis, the geographical region of presentation and the development and access to new drugs, among other factors. Most acute presentation forms are self-limiting and may even go unnoticed, with just a small percentage of cases leading to acute liver failure that may necessitate transplantation or even cause the death of the patient. However, when they become chronic, as in the case of hepatitis B virus and C virus, unless they are diagnosed and treated adequately they may have severe consequences, like cirrhosis or hepatocarcinoma. Understanding of the mechanisms of transmission, the pathogenesis, the presence of vaccinations and the development over recent years of new highly-efficient, potent drugs have meant that we are now faced with a new scenario in the management of viral hepatitis, particularly hepatitis B virus and hepatitis C virus. The spectacular advances in hepatitis C virus treatment have led the World Health Organization to propose the objective of its eradication by 2030. The key aspect to achieving this goal is to ensure that these treatments reach all the more vulnerable population groups, in whom the different types of viral hepatitis have a high prevalence and constitute a niche that may perpetuate infection and hinder its eradication. Accordingly, micro-elimination programs assume special relevance at the present time.

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Therapy With Direct-Acting Antiviral Agents for Hepatitis C in Liver Transplant Recipients

Cited by 6 publications

References 7 publications

Are Hepatitis C Positive Female Liver Transplant Recipients Still at Increased Risk for Graft Failure? Reexamining the Disparity in the Modern Era of Direct-acting Antiviral Agents

Are Hepatitis C Positive Female Liver Transplant Recipients Still at Increased Risk for Graft Failure? Reexamining the Disparity in the Modern Era of Direct-acting Antiviral Agents

Therapy with Direct-Acting Antiviral Agents in Transplanted Patients with HCV Recurrence: A Retrospective Analysis

Present and future management of viral hepatitis

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