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 language | English (US) |
|---|---|
| Pages (from-to) | 570-574 |
| Number of pages | 5 |
| Journal | Annals of Transplantation |
| Volume | 22 |
| DOIs | |
| State | Published - Sep 22 2017 |
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Keywords
- Hepatitis C
- Liver transplantation
- Treatment outcome
ASJC Scopus subject areas
- Transplantation
Cite this
Single-center experience in pre-transplant hepatitis c virus (HCV) treatment among living donor liver transplant candidates : Bridging the direct-acting antivirals (DAA). / Niranjan-Azadi, Ashwini; Kabacam, Gokhan; Durand, Christine; Anjum, Saad; Saberi, Behnam; Dagher, Nabil N.; Philosophe, Benjamin; Gurakar, Ahmet.
In: Annals of Transplantation, Vol. 22, 22.09.2017, p. 570-574.Research output: Contribution to journal › Article
}
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
UR - http://www.scopus.com/inward/record.url?scp=85030251645&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85030251645&partnerID=8YFLogxK
U2 - 10.12659/AOT.905649
DO - 10.12659/AOT.905649
M3 - Article
VL - 22
SP - 570
EP - 574
JO - Annals of Transplantation
JF - Annals of Transplantation
SN - 1425-9524
ER -