Pre-emptive pangenotypic direct acting antiviral therapy in donor HCV-positive to recipient HCV-negative heart transplantation: an open-label study

Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

“…Emerging data suggest that initiating prophylactic/ preemptive DAA therapy before viremia occurs reduces the likelihood of complications, such as fibrosing cholestatic hepatitis. (359,(373)(374)(375)(376) The prophylactic/preemptive approach may also allow for a shorter duration of DAA treatment, (359,377) although this is not currently recommended outside of a clinical trial setting.…”

“…Limited short-term data from liver, (340,357,390,391) kidney, (358,(378)(379)(380)(390)(391)(392)(393)(394) heart, (359,373,390,395) and lung (359,374) transplant programs performing solid organ transplantations involving HCV-viremic donors and HCV-negative recipients are encouraging. However, the overall number of published cases is limited, and treatment approaches varied.…”

Immediate administration of antiviral therapy after transplantation of hepatitis C-infected livers into uninfected recipients: Implications for therapeutic planning

“…Our findings build on a growing body of evidence that supports the efficacy and safety of utilizing DAAs as part of an immediate strategy in organ transplantation . This strategy involves administering treatment prior to, or within hours to days of transplantation, before HCV‐specific genotype and viral load information are available.…”

“…Despite considerable promise shown by our interim results, the long‐term outcomes of transplanting viremic livers into HCV‐negative recipients, including impact on the incidence of acute rejection, chronic rejection, and 1‐year graft and patient survival rates, have yet to be established. However, based on the success with other solid organ HCV donor‐positive to recipient‐negative transplants, the expectation is that graft outcomes will be excellent in the setting of SVR12, supporting the generalizability of this approach . Continued patient monitoring will enable us to investigate these long‐term outcomes.…”

“…In the transplant population, DAAs have been shown to effectively induce SVR in HCV‐negative recipients transplanted with viremic organs, when administered as part of a reactive treatment approach, after detection of viremia . Preemptive or early treatment with DAAs, prior to development of viremia, reduces recipient risk and has been recently evaluated in a small number of studies involving kidney, heart, and lung transplantation . However, the challenge of obtaining insurance coverage for preemptive or early treatment has impeded efforts to implement this approach outside of industry‐sponsored trials.…”