Single-center experience in pre-transplant hepatitis c virus (HCV) treatment among living donor liver transplant candidates

Bridging the direct-acting antivirals (DAA)

Ashwini Niranjan-Azadi, Gokhan Kabacam, Christine Durand, Saad Anjum, Behnam Saberi, Nabil N. Dagher, Benjamin Philosophe, Ahmet Gurakar

Research output: Contribution to journalArticle

Abstract

Background: Treatment with DAAs before deceased donor liver transplantation has been shown to be an effective strategy to prevent post-transplant HCV recurrence, with a 95% cure-rate among individuals who achieve undetectable HCV VL for ≥ 30 days pre-transplant. This strategy has not been evaluated in LDLT. Material/Methods: We evaluated outcomes in LDLT recipients treated with DAAs pre-transplant and bridged with 4 weeks of posttransplant SOF. All cases of LDLT at Johns Hopkins (1/1/2014-3/1/15) were retrospectively reviewed. Results: There were 4 HCV+ LDLT cases treated with DAAs pre- and post-transplant. Pre-transplant DAA regimens included SOF plus SIM in 2 cases of HCC and SOF plus RBV in 2 cases of ESLD. All patients achieved negative VL by week 7 of treatment and all patients had at least 30 days of HCV RNA negativity at the time of LDLT. Patient 4 had a delay in LDLT due to uncontrolled pulmonary hypertension, and experienced viral breakthrough because of treatment interruption. Due to concerns for SOF resistance, a salvage regimen of LDV-SOF and SIM was used. Post-LDLT patients 1-3 received 4 weeks of SOF monotherapy and patient 4 received 14 weeks of LDV-SOF. Three patients achieved SVR12. One died from non-HCV related complications at 4 months post-LDLT. Conclusions: Our preliminary experience suggests that bridging DAAs pre- and post-LDLT is an effective strategy to prevent HCV recurrence. With delays in transplant and prolonged use of SOF/RBV, there is a risk of viral breakthrough, but a salvage strategy of triple DAA therapy can be effective.

Original languageEnglish (US)
Pages (from-to)570-574
Number of pages5
JournalAnnals of Transplantation
Volume22
DOIs
StatePublished - Sep 22 2017

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Hepatitis Viruses
Living Donors
Antiviral Agents
Transplants
Liver
Therapeutics
Recurrence
Pulmonary Hypertension
Liver Transplantation
Tissue Donors
RNA
Viruses

Keywords

  • Hepatitis C
  • Liver transplantation
  • Treatment outcome

ASJC Scopus subject areas

  • Transplantation

Cite this

@article{6668c620c6f0423fbb5673f0a517d5d0,
title = "Single-center experience in pre-transplant hepatitis c virus (HCV) treatment among living donor liver transplant candidates: Bridging the direct-acting antivirals (DAA)",
abstract = "Background: Treatment with DAAs before deceased donor liver transplantation has been shown to be an effective strategy to prevent post-transplant HCV recurrence, with a 95{\%} cure-rate among individuals who achieve undetectable HCV VL for ≥ 30 days pre-transplant. This strategy has not been evaluated in LDLT. Material/Methods: We evaluated outcomes in LDLT recipients treated with DAAs pre-transplant and bridged with 4 weeks of posttransplant SOF. All cases of LDLT at Johns Hopkins (1/1/2014-3/1/15) were retrospectively reviewed. Results: There were 4 HCV+ LDLT cases treated with DAAs pre- and post-transplant. Pre-transplant DAA regimens included SOF plus SIM in 2 cases of HCC and SOF plus RBV in 2 cases of ESLD. All patients achieved negative VL by week 7 of treatment and all patients had at least 30 days of HCV RNA negativity at the time of LDLT. Patient 4 had a delay in LDLT due to uncontrolled pulmonary hypertension, and experienced viral breakthrough because of treatment interruption. Due to concerns for SOF resistance, a salvage regimen of LDV-SOF and SIM was used. Post-LDLT patients 1-3 received 4 weeks of SOF monotherapy and patient 4 received 14 weeks of LDV-SOF. Three patients achieved SVR12. One died from non-HCV related complications at 4 months post-LDLT. Conclusions: Our preliminary experience suggests that bridging DAAs pre- and post-LDLT is an effective strategy to prevent HCV recurrence. With delays in transplant and prolonged use of SOF/RBV, there is a risk of viral breakthrough, but a salvage strategy of triple DAA therapy can be effective.",
keywords = "Hepatitis C, Liver transplantation, Treatment outcome",
author = "Ashwini Niranjan-Azadi and Gokhan Kabacam and Christine Durand and Saad Anjum and Behnam Saberi and Dagher, {Nabil N.} and Benjamin Philosophe and Ahmet Gurakar",
year = "2017",
month = "9",
day = "22",
doi = "10.12659/AOT.905649",
language = "English (US)",
volume = "22",
pages = "570--574",
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TY - JOUR

T1 - Single-center experience in pre-transplant hepatitis c virus (HCV) treatment among living donor liver transplant candidates

T2 - Bridging the direct-acting antivirals (DAA)

AU - Niranjan-Azadi, Ashwini

AU - Kabacam, Gokhan

AU - Durand, Christine

AU - Anjum, Saad

AU - Saberi, Behnam

AU - Dagher, Nabil N.

AU - Philosophe, Benjamin

AU - Gurakar, Ahmet

PY - 2017/9/22

Y1 - 2017/9/22

N2 - Background: Treatment with DAAs before deceased donor liver transplantation has been shown to be an effective strategy to prevent post-transplant HCV recurrence, with a 95% cure-rate among individuals who achieve undetectable HCV VL for ≥ 30 days pre-transplant. This strategy has not been evaluated in LDLT. Material/Methods: We evaluated outcomes in LDLT recipients treated with DAAs pre-transplant and bridged with 4 weeks of posttransplant SOF. All cases of LDLT at Johns Hopkins (1/1/2014-3/1/15) were retrospectively reviewed. Results: There were 4 HCV+ LDLT cases treated with DAAs pre- and post-transplant. Pre-transplant DAA regimens included SOF plus SIM in 2 cases of HCC and SOF plus RBV in 2 cases of ESLD. All patients achieved negative VL by week 7 of treatment and all patients had at least 30 days of HCV RNA negativity at the time of LDLT. Patient 4 had a delay in LDLT due to uncontrolled pulmonary hypertension, and experienced viral breakthrough because of treatment interruption. Due to concerns for SOF resistance, a salvage regimen of LDV-SOF and SIM was used. Post-LDLT patients 1-3 received 4 weeks of SOF monotherapy and patient 4 received 14 weeks of LDV-SOF. Three patients achieved SVR12. One died from non-HCV related complications at 4 months post-LDLT. Conclusions: Our preliminary experience suggests that bridging DAAs pre- and post-LDLT is an effective strategy to prevent HCV recurrence. With delays in transplant and prolonged use of SOF/RBV, there is a risk of viral breakthrough, but a salvage strategy of triple DAA therapy can be effective.

AB - Background: Treatment with DAAs before deceased donor liver transplantation has been shown to be an effective strategy to prevent post-transplant HCV recurrence, with a 95% cure-rate among individuals who achieve undetectable HCV VL for ≥ 30 days pre-transplant. This strategy has not been evaluated in LDLT. Material/Methods: We evaluated outcomes in LDLT recipients treated with DAAs pre-transplant and bridged with 4 weeks of posttransplant SOF. All cases of LDLT at Johns Hopkins (1/1/2014-3/1/15) were retrospectively reviewed. Results: There were 4 HCV+ LDLT cases treated with DAAs pre- and post-transplant. Pre-transplant DAA regimens included SOF plus SIM in 2 cases of HCC and SOF plus RBV in 2 cases of ESLD. All patients achieved negative VL by week 7 of treatment and all patients had at least 30 days of HCV RNA negativity at the time of LDLT. Patient 4 had a delay in LDLT due to uncontrolled pulmonary hypertension, and experienced viral breakthrough because of treatment interruption. Due to concerns for SOF resistance, a salvage regimen of LDV-SOF and SIM was used. Post-LDLT patients 1-3 received 4 weeks of SOF monotherapy and patient 4 received 14 weeks of LDV-SOF. Three patients achieved SVR12. One died from non-HCV related complications at 4 months post-LDLT. Conclusions: Our preliminary experience suggests that bridging DAAs pre- and post-LDLT is an effective strategy to prevent HCV recurrence. With delays in transplant and prolonged use of SOF/RBV, there is a risk of viral breakthrough, but a salvage strategy of triple DAA therapy can be effective.

KW - Hepatitis C

KW - Liver transplantation

KW - Treatment outcome

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U2 - 10.12659/AOT.905649

DO - 10.12659/AOT.905649

M3 - Article

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EP - 574

JO - Annals of Transplantation

JF - Annals of Transplantation

SN - 1425-9524

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