22 September 2017 : Original article
Single-Center Experience in Pre-transplant Hepatitis C Virus (HCV) Treatment Among Living Donor Liver Transplant Candidates: Bridging the Direct-Acting Antivirals (DAA)
Ashwini M. Niranjan-Azadi1BCDEF, Gokhan Kabacam2EF, Christine M. Durand3ABCDE, Saad Anjum4DE, Behnam Saberi2DE, Nabil N. Dagher5ABDE, Benjamin Philosophe6DE, Ahmet Gurakar2BDEF*DOI: 10.12659/AOT.905649
Ann Transplant 2017; 22:570-574
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 AND METHODS: We evaluated outcomes in LDLT recipients treated with DAAs pre-transplant and bridged with 4 weeks of post-transplant 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.
Keywords: Hepatitis C, Liver Transplantation
938 7
In Press
10 Nov 2023 : Original article
Effects of Preservation of Donor Liver Gastroduodenal Artery on Post-Transplant Biliary Complications in 18...Ann Transplant In Press; DOI:
07 Nov 2023 : Original article
Allogeneic Hematopoietic Stem Cell Transplantation Can Improve Prognosis of Extramedullary Infiltration Pos...Ann Transplant In Press; DOI:
06 Nov 2023 : Original article
Clinical Outcomes of Administration of Rituximab for Desensitization in Liver Transplant Patients with Pref...Ann Transplant In Press; DOI:
06 Nov 2023 : Original article
Short-Term Monitoring of Graft Regeneration in Partial Liver Transplantation RecipientsAnn Transplant In Press; DOI:
Most Viewed Current Articles
24 Aug 2021 : Review article
Normothermic Machine Perfusion (NMP) of the Liver – Current Status and Future PerspectivesDOI :10.12659/AOT.931664
Ann Transplant 2021; 26:e931664
26 Jan 2022 : Review article
Recurrence of Hepatocellular Carcinoma After Liver Transplantation: Risk Factors and Predictive ModelsDOI :10.12659/AOT.934924
Ann Transplant 2022; 27:e934924
29 Dec 2021 : Original article
Efficacy and Safety of Tacrolimus-Based Maintenance Regimens in De Novo Kidney Transplant Recipients: A Sys...DOI :10.12659/AOT.933588
Ann Transplant 2021; 26:e933588
15 Mar 2022 : Case report
Combined Liver, Pancreas-Duodenum, and Kidney Transplantation for Patients with Hepatitis B Cirrhosis, Urem...DOI :10.12659/AOT.935860
Ann Transplant 2022; 27:e935860