Real-world Experiences in the Transplantation of Hepatitis C-NAAT-positive Organs.
Journal
Transplantation direct
ISSN: 2373-8731
Titre abrégé: Transplant Direct
Pays: United States
ID NLM: 101651609
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
received:
21
07
2023
accepted:
12
08
2023
medline:
13
10
2023
pubmed:
13
10
2023
entrez:
13
10
2023
Statut:
epublish
Résumé
Hepatitis C virus (HCV) nucleic acid amplification test (NAAT)-positive donors have increased the organ pool. Direct-acting antivirals (DAAs) have led to high rates of treatment success and sustained virologic response (SVR) in recipients with donor-derived HCV infection without significant adverse effects, although variability remains in the timing and duration of antivirals. This retrospective study analyzed all adult HCV-NAAT-negative transplant recipients who received an organ from HCV-NAAT-positive donors from November 24, 2018, to March 31, 2022, at Duke University Medical Center with protocolized delay of DAA initiation until after hospital discharge, with at least 180-d follow-up on all patients. Transplant and HCV-related outcomes were analyzed. Two hundred eleven transplants (111 kidneys, 41 livers, 34 hearts, and 25 lungs) were performed from HCV-NAAT-positive donors to HCV-NAAT-negative recipients. Ninety percent of recipients became viremic within 7 d posttransplant. Ninety-nine percent of recipients were initiated on pangenotypic DAAs in the outpatient setting a median of 52 d posttransplant, most commonly with 12-wk courses of sofosbuvir-velpatasvir (lungs) and glecaprevir-pibrentasvir (heart, kidney, and liver). Ninety-seven percent of recipients had SVR after a first-line DAA; all ultimately achieved SVR at 12 wk after subsequent treatment courses. The median peak HCV RNA for all organ systems was 2 436 512 IU/mL; the median time from antiviral to undetectable RNA was 48 d, although differences were noted between organ groups. No patient deaths or graft losses were directly attributable to HCV infection. One hundred percent of transplant recipients of HCV-NAAT-positive organs ultimately developed SVR without significant adverse effects when HCV antivirals were initiated in the outpatient setting after transplant hospitalization, suggesting that this real-world treatment pathway is a viable option.
Sections du résumé
Background
UNASSIGNED
Hepatitis C virus (HCV) nucleic acid amplification test (NAAT)-positive donors have increased the organ pool. Direct-acting antivirals (DAAs) have led to high rates of treatment success and sustained virologic response (SVR) in recipients with donor-derived HCV infection without significant adverse effects, although variability remains in the timing and duration of antivirals.
Methods
UNASSIGNED
This retrospective study analyzed all adult HCV-NAAT-negative transplant recipients who received an organ from HCV-NAAT-positive donors from November 24, 2018, to March 31, 2022, at Duke University Medical Center with protocolized delay of DAA initiation until after hospital discharge, with at least 180-d follow-up on all patients. Transplant and HCV-related outcomes were analyzed.
Results
UNASSIGNED
Two hundred eleven transplants (111 kidneys, 41 livers, 34 hearts, and 25 lungs) were performed from HCV-NAAT-positive donors to HCV-NAAT-negative recipients. Ninety percent of recipients became viremic within 7 d posttransplant. Ninety-nine percent of recipients were initiated on pangenotypic DAAs in the outpatient setting a median of 52 d posttransplant, most commonly with 12-wk courses of sofosbuvir-velpatasvir (lungs) and glecaprevir-pibrentasvir (heart, kidney, and liver). Ninety-seven percent of recipients had SVR after a first-line DAA; all ultimately achieved SVR at 12 wk after subsequent treatment courses. The median peak HCV RNA for all organ systems was 2 436 512 IU/mL; the median time from antiviral to undetectable RNA was 48 d, although differences were noted between organ groups. No patient deaths or graft losses were directly attributable to HCV infection.
Conclusions
UNASSIGNED
One hundred percent of transplant recipients of HCV-NAAT-positive organs ultimately developed SVR without significant adverse effects when HCV antivirals were initiated in the outpatient setting after transplant hospitalization, suggesting that this real-world treatment pathway is a viable option.
Identifiants
pubmed: 37829247
doi: 10.1097/TXD.0000000000001539
pmc: PMC10567032
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e1539Informations de copyright
Copyright © 2023 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
The authors declare no funding or conflicts of interest.
Références
Am J Health Syst Pharm. 2020 Jul 7;77(14):1149-1152
pubmed: 32537658
ASAIO J. 2013 Nov-Dec;59(6):660-1
pubmed: 24088900
Kidney Int Rep. 2021 Dec 01;7(2):241-250
pubmed: 35155863
Am J Transplant. 2022 Feb;22(2):599-609
pubmed: 34613666
Hepatology. 2020 Jul;72(1):32-41
pubmed: 31659775
Transpl Infect Dis. 2022 Aug;24(4):e13887
pubmed: 35752929
Ann Intern Med. 2018 Sep 4;169(5):273-281
pubmed: 30083748
J Gen Intern Med. 2018 Apr;33(4):551-557
pubmed: 29352420
Am J Kidney Dis. 2023 Sep;82(3):368-372
pubmed: 36740039
Lancet Gastroenterol Hepatol. 2020 Jul;5(7):649-657
pubmed: 32389183
Hepatology. 2018 Oct;68(4):1298-1307
pubmed: 29672891
N Engl J Med. 2015 Dec 31;373(27):2599-607
pubmed: 26571066
Drugs. 2017 Feb;77(2):131-144
pubmed: 28074358
J Heart Lung Transplant. 2020 Nov;39(11):1199-1207
pubmed: 32739334
Ann Intern Med. 2018 Apr 17;168(8):533-540
pubmed: 29507971
N Engl J Med. 2019 Apr 25;380(17):1606-1617
pubmed: 30946553
N Engl J Med. 2018 Jan 25;378(4):354-369
pubmed: 29365309
J Hepatol. 2020 Mar;72(3):441-449
pubmed: 31682879
N Engl J Med. 2015 Dec 31;373(27):2608-17
pubmed: 26575258
Am J Transplant. 2019 Sep;19(9):2525-2532
pubmed: 31066215
Am J Transplant. 2021 Nov;21(11):3734-3742
pubmed: 34212479
Transplantation. 2005 Aug 15;80(3):320-5
pubmed: 16082326
J Thorac Dis. 2017 Jan;9(1):205-210
pubmed: 28203425
N Engl J Med. 2014 May 15;370(20):1889-98
pubmed: 24725239
Am J Transplant. 2020 Mar;20(3):739-751
pubmed: 31652392
Am J Transplant. 2019 Nov;19(11):3046-3057
pubmed: 31306549
J Pharm Pract. 2023 Apr;36(2):264-270
pubmed: 34289722