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Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms [e-pub ahead of print]. Brain Behav Immun

Background: The use of direct-acting antivirals (DAA) has expanded transplantation from hepatitis C viremic donors (HCV-VIR). Our team has conducted an open-label, prospective trial to assess outcomes transplanting HCV viremic hearts. Glecaprevir/ pibrentasvir (GLE/PIB) was our sole DAA. Methods: Serial quantitative hepatitis C virus (HCV) RNA PCR was obtained to as

We conducted a retrospective review of thoracic transplant recipients (22 heart and 16 lung transplant recipients) prospectively enrolled in a single‐center observational study of HCV NAT+ organ transplantation in HCV NAT− recipients. All recipients were treated with 8 weeks of glecaprevir‐pibrentasvir (GP) for HCV viremia in addition to standard triple immunosuppression post‐transplant. Thoracic transplant recipients of HCV NAT− organs were used as a control (24 heart and 22 lung transplant recipients). Our primary outcome was to assess the effect of GP on tacrolimus dose requirements. Secondary objectives included assessing drug interactions with common post‐transplant medications, adverse effects, and the need to hold or discontinue GP therapy. The median tacrolimus concentration‐to‐dose ratio (CDR) in the cohort was 184 (99‐260) during GP therapy and 154 (78‐304) over the first month after GP (P = .79). Trends in median tacrolimus CDR were similar on a per‐week basis and per‐patient basis. In three instances, concomitant posaconazole and GP led to hyperbilirubinemia and interruption of posaconazole. GP therapy was held in one heart transplant recipient and discontinued in another due to unresolving hyperbilirubinemia. Utilization of GP to treat HCV viremia post–thoracic transplant is feasible and safe, but requires modifications to post‐transplant pharmacotherapy and careful monitoring for adverse effects.

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