HCV+ liver transplant: DAAs achieve 96% clearance rate in viremic recipients

  • Kapila N & al.
  • J Clin Transl Hepatol
  • 28.06.2019

  • von Yael Waknine
  • Clinical Essentials
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Takeaway

  • Direct-acting antivirals (DAAs) are associated with a 95.8% clearance rate among HCV+ recipients of viremic liver transplant.

Why this matters

  • HCV+ organs have become more ubiquitous during the current opioid crisis yet remain underused; this study adds evidence for their viability.

Study design

  • Study of 24 HCV+ patients (67% male; median age, 63 years; HCV-1a, 79.2%) receiving livers from HCV+ donors; 5 (20.8%) underwent a combined liver-kidney transplant.
  • Most had HCV-1a (79.2%) and were treatment-experienced (54.2%; DAAs, 8.3%); 45.8% had hepatocellular carcinoma at transplant.
  • Median modified model for end-stage liver disease score, 19 (range, 14-35).
  • Median waitlist time, 81 (range, 4-397) days.
  • Funding: None disclosed.

Key results

  • Median time from transplant to DAA therapy, 123 (range, 10-350) days.
  • 3 patients (12.5%) transitioned to a different HCV genotype posttransplant.
  • Most received 12-24 weeks of sofosbuvir combined with ledipasvir (Harvoni, 83.3%), velpatasvir (Epclusa, 8.3%), or daclatasvir (Sovaldi/Daklinza, 4.2%); 62.5% of courses were ribavirin-free.
  • 95.8% achieved sustained virologic response at 12 weeks posttreatment (SVR12).
    • Data for 17 patients showed 100% sustained clearance at week 24.
  • Adverse events (20.8%) did not require discontinuation.
  • 2 patients (1 nonresponse, 1 relapse) were successfully retreated with glecaprevir/pibrentasvir (Mavyret) and sofosbuvir/velpatasvir/voxilaprevir (Vosevi), respectively.

Limitations

  • Retrospective design.
  • Small sample size.
  • Regimen heterogeneity.