Preemptive DAA therapy improves outcomes of negative-to-positive HCV heart transplant
SAN FRANCISCO — Preemptive administration of pangenotypic direct-acting antiviral therapy resulted in rapid viral suppression of hepatitis C in patients without HCV who received a heart transplantation with an HCV-positive organ, according to data presented at The Liver Meeting 2018.
“With the rising number of HCV-positive donors, there is a time-sensitive and critical need to document both the efficacy and detailed implementation strategies surrounding successful use of HCV-positive organs,” Emily Bethea, MD, Massachusetts General Hospital, said in her presentation.
The open label, proof-of-concept trial comprised 25 patients listed for cardiac transplantation who were willing to accept a donor heart that was positive for HCV based on nucleic acid testing.
Eight patients who received an offer for an HCV-positive donor heart started preemptive DAA therapy with Mavyret (glecaprevir/pibrentasvir, AbbVie). They received their first dose prior to transport to the operating room and then completed an 8-week course.
All eight patients achieved viral suppression with undetectable or nonquantifiable HCV RNA by day 7 posttransplant.
No treatment failures have occurred to date. All HCV viral load checks have remained negative from time of hospital discharge. Additionally, the researchers observed no adverse drug reactions or interactions that would require a lapse or discontinuation of therapy.
“Preliminary analysis indicates a decrease in time to transplant in patients willing to accept an HCV-positive heart, and posttransplant outcomes have been excellent in this small cohort of patients,” Bethea said. “This novel strategy has the potential to increase the cardiac donor pool, decrease heart transplant wait times and improve health outcomes.” – by Talitha Bennett
Bethea E, et al. Abstract 0007. Presented at: The Liver Meeting 2018; Nov. 9-13, 2018; San Francisco.
Disclosure: Bethea reports no relevant financial disclosures.