Summary: Treatment of HCV-Uninfected Transplant Recipients Receiving Organs From HCV-Viremic Donors
Recommendations When Considering Use of HCV-Viremic Donor Organs in HCV-Uninfected Recipients
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RECOMMENDED
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RATING 
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Informed consent should include the following elements:
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Risk of transmission from an HCV-viremic donor
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Risk of liver disease if HCV treatment is not available or treatment is unsuccessful
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Risk of graft failure
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Risk of extrahepatic complications, such as HCV-associated renal disease
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Risk of HCV transmission to partner
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Benefits, specifically reduced waiting time and possibly lower waiting list mortality
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Other unknown long-term consequences (hepatic and extrahepatic) of HCV exposure (even if cure is attained)
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I, C
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Transplant programs should have a programmatic strategy to:
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Document informed consent
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Assure access to HCV treatment and retreatment(s), as necessary
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Ensure long-term follow-up of recipients (beyond SVR12)
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I, C
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Recommendation Regarding Timing of DAA Therapy for HCV-Negative Recipients of HCV-Viremic Liver Transplant
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RECOMMENDED
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RATING
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Earlya treatment with a pangenotypic DAA regimen is recommended when the patient is clinically stable.
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II, B
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a Early treatment refers to starting within the first 2 weeks after liver transplant but preferably within the first week when the patient is clinically stable.
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Recommended regimens listed by pangenotypic, evidence level and alphabetically for:
Treatment of HCV-Uninfected Recipients of Liver Grafts from HCV-Viremic Donors
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RECOMMENDED
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DURATION
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RATING
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Daily fixed-dose combination of glecaprevir (300 mg)/pibrentasvir (120 mg)b
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12 weeks
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I, C
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Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg)
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12 weeks
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I, C
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a Other considerations in selection of the DAA regimen:
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Presence of liver dysfunction (eg, elevated bilirubin) as protease inhibitors should be avoided
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Specific drugs that are contraindicated or not recommended with specific DAA agents, including but not limited to:
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High-dose antacid therapy (eg, twice daily proton pump inhibitor)
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Amiodarone (contraindicated with sofosbuvir-inclusive regimens; see prescribing information)
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Specific statins (eg, atorvastatin)
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Consideration of immunosuppressive drugs and DAA interactions (see below)
b Dosing is 3 coformulated tablets (glecaprevir [100 mg]/pibrentasvir [40 mg]) taken once daily. Please refer to the prescribing information.
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Recommendation Regarding Timing of DAA Therapy for HCV-Negative Recipients of HCV-Viremic Non-Liver Solid Organ Transplant
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RECOMMENDED
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RATING
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Prophylactica or preemptiveb treatment with a pangenotypic DAA regimen is recommended.
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II, B
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a Initiate DAA therapy immediately pretransplant or on day 0 posttransplant. No HCV RNA testing of the transplant recipient is required
b Initiate DAA therapy on day 0 to day 7 posttransplant, as soon as the patient is clinically stable. Demonstration of HCV viremia in the transplant recipient is not required
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Recommended regimens listed by pangenotypic, evidence level and alphabetically for:
Treatment of HCV-Uninfected Recipients of Non-Liver Organs from HCV-Viremic Donors
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RECOMMENDED
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DURATION
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RATING
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Daily fixed-dose combination of glecaprevir (300 mg)/pibrentasvir (120 mg)b
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8 weeks
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I, C
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Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg)
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12 weeks
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I, C
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a Other considerations in selection of the DAA regimen:
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Presence of liver dysfunction (eg, elevated bilirubin) as protease inhibitors should be avoided
-
Specific drugs that are contraindicated or not recommended with specific DAA agents, including but not limited to:
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High-dose antacid therapy (eg, twice daily proton pump inhibitor)
-
Amiodarone (contraindicated with sofosbuvir-inclusive regimens; see prescribing information)
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Specific statins (eg, atorvastatin)
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Consideration of immunosuppressive drugs and DAA interactions (see below)
b 8 weeks is recommended for prophylactic/preemptive treatment approaches. However, if treatment initiation is delayed beyond the first week after transplant, treatment should be continued for 12 weeks. Dosing is 3 coformulated tablets (glecaprevir [100 mg]/pibrentasvir [40 mg]) taken once daily. Please refer to the prescribing information.
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