Published on HCV Guidance (https://www.hcvguidelines.org)

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

RECOMMENDED

RATING

Informed consent should include the following elements:

Risk of transmission from an HCV-viremic donor
Risk of liver disease if HCV treatment is not available or treatment is unsuccessful
Risk of graft failure
Risk of extrahepatic complications, such as HCV-associated renal disease
Risk of HCV transmission to partner
Benefits, specifically reduced waiting time and possibly lower waiting list mortality
Other unknown long-term consequences (hepatic and extrahepatic) of HCV exposure (even if cure is attained)

I, C

Transplant programs should have a programmatic strategy to:

Document informed consent
Assure access to HCV treatment and retreatment(s), as necessary
Ensure long-term follow-up of recipients (beyond SVR12)

I, C

Recommendation Regarding Timing of DAA Therapy for HCV-Negative Recipients of HCV-Viremic Liver Transplant
RECOMMENDED	RATING
Early^a treatment with a pangenotypic DAA regimen is recommended when the patient is clinically stable.	II, B
^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.

Recommended regimens listed by pangenotypic, evidence level and alphabetically for: Treatment of HCV-Uninfected Recipients of Liver Grafts from HCV-Viremic Donors
RECOMMENDED	DURATION	RATING
Daily fixed-dose combination of glecaprevir (300 mg)/pibrentasvir (120 mg)^b	12 weeks	I, C
Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg)	12 weeks	I, C
^a Other considerations in selection of the DAA regimen: 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: High-dose antacid therapy (eg, twice daily proton pump inhibitor) Amiodarone (contraindicated with sofosbuvir-inclusive regimens; see prescribing information) Specific statins (eg, atorvastatin) 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.

Recommendation Regarding Timing of DAA Therapy for HCV-Negative Recipients of HCV-Viremic Non-Liver Solid Organ Transplant
RECOMMENDED	RATING
Prophylactic^a or preemptive^b treatment with a pangenotypic DAA regimen is recommended.	II, B
^a Initiate DAA therapy immediately pretransplant or on day 0 posttransplant. No HCV RNA testing of the transplant recipient is required ^bInitiate 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

Recommended regimens listed by pangenotypic, evidence level and alphabetically for: Treatment of HCV-Uninfected Recipients of Non-Liver Organs from HCV-Viremic Donors
RECOMMENDED	DURATION	RATING
Daily fixed-dose combination of glecaprevir (300 mg)/pibrentasvir (120 mg)^b	8 weeks	I, C
Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg)	12 weeks	I, C
^a Other considerations in selection of the DAA regimen: 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: High-dose antacid therapy (eg, twice daily proton pump inhibitor) Amiodarone (contraindicated with sofosbuvir-inclusive regimens; see prescribing information) Specific statins (eg, atorvastatin) 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.

Last update:

December 19, 2023