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Real-world Experiences in the Transplantation of Hepatitis C-NAAT-positive Organs.

Publication ,  Journal Article
Steinbrink, JM; Byrns, J; Berg, C; Kappus, M; King, L; Ellis, MJ; Sanoff, S; Agarwal, R; DeVore, AD; Reynolds, JM; Hartwig, MG; Milano, C ...
Published in: Transplant Direct
November 2023

BACKGROUND: Hepatitis C virus (HCV) nucleic acid amplification test (NAAT)-positive donors have increased the organ pool. Direct-acting antivirals (DAAs) have led to high rates of treatment success and sustained virologic response (SVR) in recipients with donor-derived HCV infection without significant adverse effects, although variability remains in the timing and duration of antivirals. METHODS: This retrospective study analyzed all adult HCV-NAAT-negative transplant recipients who received an organ from HCV-NAAT-positive donors from November 24, 2018, to March 31, 2022, at Duke University Medical Center with protocolized delay of DAA initiation until after hospital discharge, with at least 180-d follow-up on all patients. Transplant and HCV-related outcomes were analyzed. RESULTS: Two hundred eleven transplants (111 kidneys, 41 livers, 34 hearts, and 25 lungs) were performed from HCV-NAAT-positive donors to HCV-NAAT-negative recipients. Ninety percent of recipients became viremic within 7 d posttransplant. Ninety-nine percent of recipients were initiated on pangenotypic DAAs in the outpatient setting a median of 52 d posttransplant, most commonly with 12-wk courses of sofosbuvir-velpatasvir (lungs) and glecaprevir-pibrentasvir (heart, kidney, and liver). Ninety-seven percent of recipients had SVR after a first-line DAA; all ultimately achieved SVR at 12 wk after subsequent treatment courses. The median peak HCV RNA for all organ systems was 2 436 512 IU/mL; the median time from antiviral to undetectable RNA was 48 d, although differences were noted between organ groups. No patient deaths or graft losses were directly attributable to HCV infection. CONCLUSIONS: One hundred percent of transplant recipients of HCV-NAAT-positive organs ultimately developed SVR without significant adverse effects when HCV antivirals were initiated in the outpatient setting after transplant hospitalization, suggesting that this real-world treatment pathway is a viable option.

Duke Scholars

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Published In

Transplant Direct

DOI

ISSN

2373-8731

Publication Date

November 2023

Volume

9

Issue

11

Start / End Page

e1539

Location

United States

Related Subject Headings

  • 3204 Immunology
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
 

Citation

APA
Chicago
ICMJE
MLA
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Steinbrink, J. M., Byrns, J., Berg, C., Kappus, M., King, L., Ellis, M. J., … Wolfe, C. R. (2023). Real-world Experiences in the Transplantation of Hepatitis C-NAAT-positive Organs. Transplant Direct, 9(11), e1539. https://doi.org/10.1097/TXD.0000000000001539
Steinbrink, Julie M., Jennifer Byrns, Carl Berg, Matthew Kappus, Lindsay King, Matthew J. Ellis, Scott Sanoff, et al. “Real-world Experiences in the Transplantation of Hepatitis C-NAAT-positive Organs.Transplant Direct 9, no. 11 (November 2023): e1539. https://doi.org/10.1097/TXD.0000000000001539.
Steinbrink JM, Byrns J, Berg C, Kappus M, King L, Ellis MJ, et al. Real-world Experiences in the Transplantation of Hepatitis C-NAAT-positive Organs. Transplant Direct. 2023 Nov;9(11):e1539.
Steinbrink, Julie M., et al. “Real-world Experiences in the Transplantation of Hepatitis C-NAAT-positive Organs.Transplant Direct, vol. 9, no. 11, Nov. 2023, p. e1539. Pubmed, doi:10.1097/TXD.0000000000001539.
Steinbrink JM, Byrns J, Berg C, Kappus M, King L, Ellis MJ, Sanoff S, Agarwal R, DeVore AD, Reynolds JM, Hartwig MG, Milano C, Sudan D, Maziarz EK, Saullo J, Alexander BD, Wolfe CR. Real-world Experiences in the Transplantation of Hepatitis C-NAAT-positive Organs. Transplant Direct. 2023 Nov;9(11):e1539.

Published In

Transplant Direct

DOI

ISSN

2373-8731

Publication Date

November 2023

Volume

9

Issue

11

Start / End Page

e1539

Location

United States

Related Subject Headings

  • 3204 Immunology
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology