Treatment of HCV-Uninfected Transplant Recipients Receiving Organs From HCV-Viremic Donors

Recommendations When Considering Use of HCV-Viremic Donor Organs in HCV-Uninfected Recipients

RECOMMENDED

RATING

Informed consent should include the following elements:

Risk of transmission from an HCV-viremic donor (and with a PHS-defined increased risk donor, the potential risks for other viral infections)
Risk of liver disease if HCV treatment is not available or treatment is unsuccessful
Benefits, specifically reduced waiting time and possibly lower waiting list mortality
Unknown long-term consequences (hepatic and extrahepatic) of HCV exposure (even if cure is attained)
Risk of graft failure
Risk of HCV transmission to partner

I, C

Transplant programs should have a programmatic strategy to:

I, C

Recommendations Regarding Timing of DAA Therapy
RECOMMENDED	RATING
Prophylactic/preemptive treatment^a with a pangenotypic DAA regimen is recommended.	II, B
ALTERNATIVE	RATING
Treatment with a pangenotypic DAA regimen within the first week after transplantation, is a reasonable alternative. A genotype-specific regimen may be used if genotype information from the donor or recipient is available to guide therapy.	II, B
^a Prior to HCV RNA results, typically day 0 to 1 post-transplant

Recommended and alternative^a regimens listed by evidence level and alphabetically for: Treatment of HCV-Uninfected Recipients of Organs From HCV-Viremic Donors
RECOMMENDED	DURATION	RATING
Daily fixed-dose combination of glecaprevir (300 mg)/pibrentasvir (120 mg)^b	8 weeks	I, C
Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg)	12 weeks	I, C
ALTERNATIVE	DURATION	RATING
Genotype 1 and 4 only: Daily fixed-dose combination of elbasvir (50 mg)/grazoprevir (100 mg) for patients without baseline NS5A RASs^c for elbasvir	12 weeks	I, C
Genotype 1, 4, 5, or 6 only: Daily fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg)	12 weeks	I, C
^a Other considerations in selection of the DAA regimen: Presence of liver dysfunction (eg, elevated bilirubin) as protease inhibitors should be avoided Specific drugs that are contraindicated or not recommended with specific DAA agents, including but not limited to: High-dose antacid therapy (eg, twice daily proton pump inhibitor) Amiodarone (contraindicated with sofosbuvir-inclusive regimens; see prescribing information) Specific statins (eg, atorvastatin) Consideration of immunosuppressive drugs and DAA interactions (see below) ^b Dosing is 3 coformulated tablets (glecaprevir [100 mg]/pibrentasvir [40 mg]) taken once daily. Please refer to the prescribing information. ^c Includes genotype 1a resistance-associated substitutions at amino acid positions 28, 30, 31, or 93 known to confer antiviral resistance.

Last update:

December 11, 2019