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Coilly A, Jasseron C, Legeai C, Conti F, Duvoux C, Kamar N, Dharancy S, Antoine C. Impact of direct antiviral agents for hepatitis C virus -induced liver diseases on registration, waiting list and liver transplant activity in France. Clin Res Hepatol Gastroenterol 2023; 47:102168. [PMID: 37356497 DOI: 10.1016/j.clinre.2023.102168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
Direct-acting antivirals (DAA) has dramatically improved the prognosis of liver transplantation (LT) candidates for HCV end-stage liver disease (ESLD). We aimed to evaluate the impact of DAA on waiting list (WL) registration and LT activity in France. We evaluated all patients registered to the French WL for HCV ESLD between 2000 and 2018. Timespan was divided into two periods according to DAA availability: 2010-2013 versus 2014-2018. Changes in the indications of LT, outcome on WL were evaluated. Then, we evaluated the activity of LT and outcome for HCV recipients in France. Among 3,173 HCV candidates, registration on WL decreased by 33% between 2013 and 2018. The 1-year waitlist survival increased from 76.9% (95%CI: 74.2%-79.4%) in 2010-2013 to 79.8% (95%CI: 77.2%-82.1%) in 2014-2018 (p < 0.01). Regarding LT activity, the part of HCV ESLD decreased from 26% in 2010 to 16% in 2018. The 1-year graft survival rate in HCV recipients increased from 76.9% (95%CI: 73.7%-79.7%) in 2010-2012 to 84.9% (95%CI: 82.9%-86.7%) in 2013-2018 (p < 0.01). The availability of DAA to treat HCV infection is associated with a significant decrease of registration for LT, death and drop out for worsening condition on the LT. In addition, it has decreased the number of HCV+ LT and improved the 1-year graft survival in France.
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Affiliation(s)
- Audrey Coilly
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Université Paris-Saclay, UMR-S 1193, Inserm Unité 1193, FHU Hepatinov, Villejuif 94800, France.
| | - Carine Jasseron
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, 1 avenue du Stade de France, Pôle Évaluation, Saint-Denis La Plaine Cedex, 93212, France
| | - Camille Legeai
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, 1 avenue du Stade de France, Pôle Évaluation, Saint-Denis La Plaine Cedex, 93212, France
| | - Filomena Conti
- Hepatology and Liver Transplant Unit, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Christophe Duvoux
- Hepatology and Medical Liver Transplant Unit, Henri Mondor Hospital APHP- Paris Est University, Créteil, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, INSERM UMR 1291, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University Paul Sabatier, Toulouse, France
| | - Sébastien Dharancy
- Inserm, Service des Maladies de l'Appareil Digestif et de la Nutrition, Hôpital Huriez, UMR995 - LIRIC, Lille, France Univ Lille, UMR995 - LIRIC, Lille, France CHRU Lille, Lille, France
| | - Corinne Antoine
- Agence de la Biomédecine, Direction Prélèvement Greffe Organes-Tissus, 1 avenue du Stade de France, Pôle Évaluation, Saint-Denis La Plaine Cedex, 93212, France.
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2
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Kuntzen C, Bagha Z. The Use of Hepatitis C Virus-Positive Organs in Hepatitis C Virus-Negative Recipients. Clin Liver Dis 2022; 26:291-312. [PMID: 35487612 DOI: 10.1016/j.cld.2022.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The use of hepatitis C virus (HCV) -positive organs in HCV-negative recipients with posttransplant antiviral treatment has increasingly been studied since the introduction of new direct-acting antivirals. This article reviews existing experience in liver and kidney transplant. Fifteen studies with 218 HCV D+/R- liver transplants, with 182 from viremic donors, show a sustained viral response for 12 weeks (SVR12) rate of 99.5%. Nine studies involving 204 HCV donor-positive recipient-negative kidney transplant recipients had an SVR12 rate of 99.5%. Complications are infrequent. Preemptive treatment in kidney transplant of for only 4 weeks or even 4 days showed surprising success rates.
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Affiliation(s)
- Christian Kuntzen
- Hofstra University at Northwell Health, 300 Community Drive, Manhasset, NY 11030, USA.
| | - Zohaib Bagha
- Hofstra University at Northwell Health, 300 Community Drive, Manhasset, NY 11030, USA
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3
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Shabani M, Sadegh Ehdaei B, Fathi F, Dowran R. A mini-review on sofosbuvir and daclatasvir treatment in coronavirus disease 2019. New Microbes New Infect 2021; 42:100895. [PMID: 33976895 PMCID: PMC8103737 DOI: 10.1016/j.nmni.2021.100895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/01/2021] [Accepted: 05/04/2021] [Indexed: 12/28/2022] Open
Abstract
Sofosbuvir and daclatasvir have been used successfully since 2013 for hepatitis C treatment. It has been shown by different studies that sofosbuvir can inhibit RNA polymerase of other positive-strand RNA viruses including Flaviviridae and Togaviridae. Homology between hepatitis C virus RNA polymerase and severe acute respiratory syndrome coronavirus 2 has also been established. The efficacy of sofosbuvir and daclatasvir as potential choices in treating patients with coronavirus disease 2019 and their recovery can be hypothesized.
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Affiliation(s)
- M. Shabani
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - B. Sadegh Ehdaei
- Microbiology and Immunology Department, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - F. Fathi
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - R. Dowran
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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4
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Suda G, Sakamoto N. Recent advances in the treatment of hepatitis C virus infection for special populations and remaining problems. J Gastroenterol Hepatol 2021; 36:1152-1158. [PMID: 32667068 DOI: 10.1111/jgh.15189] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/02/2020] [Accepted: 07/12/2020] [Indexed: 12/16/2022]
Abstract
Hepatitis C virus (HCV) infection is one of the primary causes of liver cirrhosis, hepatocellular carcinoma (HCC), and liver transplantation (LT). The rate of HCV infection is high in patients on hemodialysis and in patients infected with human immunodeficiency virus (HIV). In liver transplant patients with HCV infection, recurrent HCV infection of the transplanted liver is universal and results in rapid liver fibrosis progression. In patients with HCV/HIV coinfection as well, liver fibrosis advances rapidly. Thus, there is an urgent need for prompt HCV infection treatment in these special populations (i.e. HIV/HCV coinfection, HCV infection after LT, and dialysis patients). Interferon (IFN)-based therapy for HCV infection could not achieve a high rate of sustained viral response and could cause severe adverse events in the aforementioned special populations. Direct-acting antivirals (DAAs) have recently been developed, and clinical trials have shown that IFN-free DAA-based therapies are associated with a significantly better safety and therapeutic profile than IFN-based therapies. However, the majority of the initial DAA trials excluded special populations; thus, the efficacy and safety of IFN-free DAA-based therapy in special populations remained to be clearly established. Although recent clinical trials and clinical studies have shown the high efficacy and safety of this therapy even in special populations, several unresolved problems, including emergence of resistance-associated variants after failure to respond to DAAs and HCC occurrence after DAA therapy, still exist. Hence, in this review, we discuss the recent advances in anti-HCV therapy for special populations and the remaining problems regarding this therapy.
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Affiliation(s)
- Goki Suda
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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5
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Boyarsky BJ, Strauss AT, Segev DL. Transplanting Organs from Donors with HIV or Hepatitis C: The Viral Frontier. World J Surg 2021; 45:3503-3510. [PMID: 33471156 DOI: 10.1007/s00268-020-05924-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2020] [Indexed: 12/21/2022]
Abstract
A wide gap between the increasing demand for organs and the limited supply leads to immeasurable loss of life each year. The organ shortage could be attenuated by donors with human immunodeficiency virus (HIV) or hepatitis C virus (HCV). The transplantation of organs from HIV+ deceased donors into HIV+ individuals (HIV D+ /R+) was initiated in South Africa in 2010; however, this practice was forbidden in the USA until the HIV Organ Policy Equity (HOPE) Act in 2013. HIV D+/R+ transplantation is now practiced in the USA as part of ongoing research studies, helping to reduce waiting times for all patients on the waitlist. The introduction of direct acting antivirals for HCV has revolutionized the utilization of donors with HCV for HCV-uninfected (HCV-) recipients. This is particularly relevant as the HCV donor pool has increased substantially in the context of the rise in deaths related to drug overdose from injection drug use. This article serves to review the current literature on using organs from donors with HIV or HCV.
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Affiliation(s)
- Brian J Boyarsky
- Department of Surgery, Epidemiology Research Group in Organ Transplantation, Johns Hopkins University School of Medicine, 2000 E Monument St, Baltimore, MD, 21205, USA
| | - Alexandra T Strauss
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorry L Segev
- Department of Surgery, Epidemiology Research Group in Organ Transplantation, Johns Hopkins University School of Medicine, 2000 E Monument St, Baltimore, MD, 21205, USA. .,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
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Aly OA, Yousry WA, Teama NM, Shona EM, ElGhandour AM. Sofosbuvir and daclatasvir are safe and effective in treatment of recurrent hepatitis C virus in Egyptian patients underwent living donor liver transplantation. EGYPTIAN LIVER JOURNAL 2020. [DOI: 10.1186/s43066-020-00056-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Abstract
Background
Liver transplant population has been considered as a special population in the treatment of hepatitis C virus infection, not only because of lower sustained virological response (SVR) rates in comparison with pretransplant setting, but also for other aspects (i.e., immunosuppressive therapy, renal function, drug–drug interactions). We aimed to evaluate the efficacy and safety of the combined treatment with sofosbuvir and daclatasvir with or without ribavirin in liver transplant recipients with recurrent hepatitis C following transplantation and screening for the development of hepatocellular carcinoma during treatment, after the end of treatment, or during follow-up. This multicenteric prospective study was conducted in Egypt. This study included 40 patients who underwent living donor liver transplantation that started treatment at least 3 months following transplantation. All participants received 400 mg sofosbuvir once daily plus daclatasvir 60 mg daily ± ribavirin. Treatment lasted for up to 24 weeks, and participants were followed up as outpatients monthly for 12 and 24 weeks and 36 weeks post-treatment to determine sustained virological response (SVR12 and SVR24), considered to be a cure and detection of any changes in tumor markers or radiological imaging during follow-up.
Results
In the current study, 40 patients (100%) have good response to treatment during treatment and during follow-up (SVR 12 was 100%). No abnormal side effects to treatment were detected; also, no drug–drug interactions were noted during the treatment.
Conclusions
Treatment of HCV after living donor liver transplantation with combined sofosbuvir and daclatasvir is safe and well-tolerated and provides high rates of SVR.
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Araujo A, Valenzuela-Granados V, Lopes AB, Michalczuk MT, Mantovani A, Alvares-da-Silva MR. Sofosbuvir-based antiviral therapy in patients with recurrent HCV infection after liver transplant: A real-life experience. Ann Hepatol 2020; 18:450-455. [PMID: 31028014 DOI: 10.1016/j.aohep.2018.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 09/16/2018] [Accepted: 09/28/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND AIM Recurrent HCV infection after liver transplant (LT) has a negative impact on graft and patient survival. The aim of this study is to describe the efficacy and safety of sofosbuvir (SOF-based) regimens in the treatment of recurrent HCV after liver transplant (LT). MATERIALS AND METHODS This retrospective study included 68 adults with recurrent HCV infection after LT, treated with different SOF-based regimens between March 2015 and December 2016. The choice of regimens, their duration and use of ribavirin (RBV) was made by the treating physician. The efficacy of antiviral treatment was assessed based on the sustained viral response obtained 12 weeks after the end of treatment (SVR12), according to an intention-to-treat analysis. RESULTS The most frequent HCV genotypes were 1 and 3 (n=35, 51.4% and n=31, 45.6%, respectively). Only 22 patients were treatment naïve (32.3%) and 7 had cirrhosis (10.2%). SOF+daclatasvir (DCV) was the most commonly used regimen (n=63, 92.6%). Most patients used RBV (n=56, 82.3%) and were treated for 12 weeks (n=66, 97%). Overall SVR12 was 95.5% (65/68 patients). Three patients had virologic failure. Three patients had serious adverse events, however, no one discontinued treatment prematurely. RBV-related anaemia was the most frequent adverse event (n=34, 50%). Four patients had severe cellular graft rejection after HCV elimination, while immunosuppression remained stable. CONCLUSION SOF-based therapy is highly effective and safe to treat HCV recurrence after LT. Cellular graft rejection following the successful treatment of HCV needs further investigation.
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Affiliation(s)
- Alexandre Araujo
- Division of Gastroenterology and Hepatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Antonio B Lopes
- Division of Gastroenterology and Hepatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Matheus T Michalczuk
- Division of Gastroenterology and Hepatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Augusto Mantovani
- Division of Gastroenterology and Hepatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Mario R Alvares-da-Silva
- Division of Gastroenterology and Hepatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; World Gastroenterology Organisation Porto Alegre Hepatology Training Center, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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8
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Japan Society of Hepatology guidelines for the management of hepatitis C virus infection: 2019 update. Hepatol Res 2020; 50:791-816. [PMID: 32343477 DOI: 10.1111/hepr.13503] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/03/2020] [Accepted: 03/22/2020] [Indexed: 12/12/2022]
Abstract
The Drafting Committee for Hepatitis Management Guidelines established by the Japan Society of Hepatology (JSH) drafted the first version of the clinical practice guidelines for the management of hepatitis C virus (HCV) infection in 2012. Since then, we have been publishing updates as new drugs for hepatitis C become available and new indications for existing drugs are added. The new approval of sofosbuvir/velpatasvir prompted us to publish the seventh version of the guidelines in Japanese in March 2019. We also published the first English-language version of the JSH guidelines in 2013 and English versions of updates made to the Japanese-language guidelines in 2014 and 2016. In 2020, the Committee has decided to publish a new English version, covering general information about treatment for hepatitis C, drugs used, recommended treatments for chronic hepatitis and cirrhosis, and special populations, such as patients who have renal impairment, are on dialysis, or have developed recurrence of hepatitis C after liver transplantation. Furthermore, the Committee has released a separate publication covering the protective effect of antiviral therapy against hepatocarcinogenesis.
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9
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Anwar N, Kaiser TE, Bari K, Schoech M, Diwan TS, Cuffy MC, Silski L, Quillin RC, Safdar K, Shah SA. Use of Hepatitis C Nucleic Acid Test-Positive Liver Allografts in Hepatitis C Virus Seronegative Recipients. Liver Transpl 2020; 26:673-680. [PMID: 32125753 DOI: 10.1002/lt.25741] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/06/2020] [Accepted: 02/25/2020] [Indexed: 02/07/2023]
Abstract
Because of underutilization of liver allografts, our center previously showed that hepatitis C virus (HCV) antibody-positive/nucleic acid test (NAT)-negative livers when transplanted into HCV nonviremic recipients were safe with a 10% risk of HCV transmission. Herein, we present our single-center prospective experience of using HCV NAT+ liver allografts transplanted into HCV NAT- recipients. An institutional review board-approved matched cohort study was conducted examining post- liver transplantation (LT) outcomes of HCV- patients who received HCV NAT+ organs (treatment group) compared with matched recipients with HCV NAT- organs (matched comparator group) between June 2018 to October 2019. The primary endpoint was success of HCV treatment and elimination of HCV infection. The secondary outcomes included the 30-day and 1-year graft and patient survival as well as perioperative complications. There were 32 recipients enrolled into each group. Because of 1 death in the index admission, 30/31 patients (97%) were given HCV treatment at a median starting time of 47 days (18-140 days) after LT. A total of 19 (63%) patients achieved sustained virological response at week 12 (SVR12). Another 6 patients achieved end-of-treatment response, while 5 remained on therapy and 1 is yet to start treatment. No HCV treatment failure has been noted. There were no differences in 30-day and 1-year graft and patient survival, length of hospital stay, biliary or vascular complications, or cytomegalovirus viremia between the 2 groups. In this interim analysis of a matched cohort study, which is the first and largest study to date, the patients who received the HCV NAT+ organs had similar outcomes regarding graft function, patient survival, and post-LT complications.
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Affiliation(s)
- Nadeem Anwar
- Digestive Disease Division, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Tiffany E Kaiser
- Digestive Disease Division, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Khurram Bari
- Digestive Disease Division, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Michael Schoech
- Digestive Disease Division, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Tayyab S Diwan
- Solid Organ Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Madison C Cuffy
- Solid Organ Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Latifa Silski
- Digestive Disease Division, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Ralph C Quillin
- Solid Organ Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kamran Safdar
- Digestive Disease Division, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Shimul A Shah
- Solid Organ Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
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Fu H, Dong J, Sun Z, Zhang X, Yu A, Chen G, Li W. Efficacy and safety of sofosbuvir-containing regimens in patients with chronic hepatitis C virus infection after liver transplantation: a meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:648. [PMID: 32566585 PMCID: PMC7290620 DOI: 10.21037/atm-20-3074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background This meta-analysis evaluated the efficacy and safety of a sofosbuvir (SOF)-containing regimen in patients with hepatitis C virus (HCV) infection after liver transplantation (LT). Methods We performed a systematic search for relevant published data on the PubMed, EMBASE, and Cochrane Library databases. Studies that evaluated any regimen in which SOF was used to treat patients with HCV infection after LT and reported the sustained virologic response 12 weeks (SVR12) after therapy were included. Results A total of 12 studies, involving 892 patients, were included in this analysis. The pooled estimate of SVR12 (sustained virologic response 12 weeks) was 88.1%. Subgroup analysis showed that patients who received SOF plus other DAAs had higher SVR12 than those treated with SOF plus ribavirin or peg-IFN. The pooled incidence of any adverse events (AEs) was 73.7%. Conclusions The results of this study showed that the treatment response of SOF-containing regimens in patients with HCV infection after LT was satisfactory. However, more attention needs to be paid to the high rate of AEs associated with such regimens.
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Affiliation(s)
- Hua Fu
- Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China.,Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Jiahong Dong
- Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China.,Center of Hepatopancreatobiliary Diseases, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Zhide Sun
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Xuejun Zhang
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Aijun Yu
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Guoli Chen
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Wei Li
- Department of Hepatobiliary Surgery, Affiliated Hospital of Chengde Medical University, Chengde, China
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11
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Al-Judaibi B, Thomas B, Wong P, Benmassaoud A, Chen JH, Dokus MK, Hussaini T, Bilodeau M, Burak KW, Marotta P, Yoshida EM. Sofosbuvir-Based Therapy in the Pre-Liver Transplant Setting: The Canadian National Experience. Ann Hepatol 2019; 17:437-443. [PMID: 29735784 DOI: 10.5604/01.3001.0011.7388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND AIM Sofosbuvir (SOF)-based regimen has been shown to have high efficacy even in patients with decompensated cirrhosis. Treated patients may experience various degrees of hepatic recovery ranging from stabilization of liver function, to removal from liver transplant wait lists. The frequency of these occurrences in larger transplant eligible patient populations is unknown. The aim of this study was to assess the efficacy of SOF-based therapy in HCV infected transplant eligible patients and to evaluate short term changes in liver function and the effect on their liver transplant status. MATERIAL AND METHODS A retrospective multicenter Canadian study of liver transplant candidates with advanced HCV cirrhosis treated with SOF-based therapy. Outcomes included sustained virologic response (SVR), and liver transplant status. RESULTS 105 liver transplant candidates with advanced liver disease due to HCV were evaluated. The overall SVR was 83.8%. Hepatocellular carcinoma was diagnosed in 39 (37.1%) prior to transplant evaluation. In short term follow-up, 14 (13.3%) remained active on the list at the time of SVR12, 22 (20.9%) patients underwent liver transplantation, 7 (6.6%) patients were deactivated due to clinical improvement, 3 patients were delisted, and 10 deaths were reported. CONCLUSIONS SOF-based therapy for patients progressing to liver transplantation leads to high SVR rates, short term stability in liver function, and deactivation from the transplant list .
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Affiliation(s)
- Bandar Al-Judaibi
- Department of Medicine, Division of Gastroenterology, Schulich School of Medicine and Dentistry at the University of Western Ontario, London, Canada
| | - Benson Thomas
- Department of Medicine, Division of Gastroenterology, Schulich School of Medicine and Dentistry at the University of Western Ontario, London, Canada
| | - Philip Wong
- Department of Medicine, Division of Gastroenterology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Canada
| | - Amine Benmassaoud
- Department of Medicine, Division of Gastroenterology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Canada
| | - Jo-Hua Chen
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - M Katherine Dokus
- Department of Medicine, Division of Gastroenterology, University of Rochester, Rochester, New York, United States of America
| | - Trana Hussaini
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Marc Bilodeau
- Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, Canada
| | - Kelly W Burak
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Alberta, Canada
| | - Paul Marotta
- Department of Medicine, Division of Gastroenterology, Schulich School of Medicine and Dentistry at the University of Western Ontario, London, Canada
| | - Eric M Yoshida
- Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, Canada
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12
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Kalafateli M, Buzzetti E, Thorburn D, Davidson BR, Tsochatzis E, Gurusamy KS. Pharmacological interventions for acute hepatitis C infection. Cochrane Database Syst Rev 2018; 12:CD011644. [PMID: 30521693 PMCID: PMC6517308 DOI: 10.1002/14651858.cd011644.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) is a single-stranded RNA (ribonucleic acid) virus that has the potential to cause inflammation of the liver. The traditional definition of acute HCV infection is the first six months following infection with the virus. Another commonly used definition of acute HCV infection is the absence of HCV antibody and subsequent seroconversion (presence of HCV antibody in a person who was previously negative for HCV antibody). Approximately 40% to 95% of people with acute HCV infection develop chronic HCV infection, that is, have persistent HCV RNA in their blood. In 2010, an estimated 160 million people worldwide (2% to 3% of the world's population) had chronic HCV infection. The optimal pharmacological treatment of acute HCV remains controversial. Chronic HCV infection can damage the liver. OBJECTIVES To assess the comparative benefits and harms of different pharmacological interventions in the treatment of acute HCV infection through a network meta-analysis and to generate rankings of the available pharmacological treatments according to their safety and efficacy. However, it was not possible to assess whether the potential effect modifiers were similar across different comparisons. Therefore, we did not perform the network meta-analysis and instead we assessed the comparative benefits and harms of different interventions versus each other or versus no intervention using standard Cochrane methodology. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Science Citation Index Expanded, World Health Organization International Clinical Trials Registry Platform, and randomised controlled trials registers to April 2016 to identify randomised clinical trials on pharmacological interventions for acute HCV infection. SELECTION CRITERIA We included only randomised clinical trials (irrespective of language, blinding, or publication status) in participants with acute HCV infection. We excluded trials which included previously liver transplanted participants and those with other coexisting viral diseases. We considered any of the various pharmacological interventions compared with placebo or each other. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We calculated the odds ratio (OR) and rate ratio with 95% confidence intervals (CI) using both fixed-effect and random-effects models based on the available-participant analysis with Review Manager 5. We assessed risk of bias according to Cochrane, controlled risk of random errors with Trial Sequential Analysis, and assessed the quality of the evidence using GRADE. MAIN RESULTS We identified 10 randomised clinical trials with 488 randomised participants that met our inclusion criteria. All the trials were at high risk of bias in one or more domains. Overall, the evidence for all the outcomes was very low quality evidence. Nine trials (467 participants) provided information for one or more outcomes. Three trials (99 participants) compared interferon-alpha versus no intervention. Three trials (90 participants) compared interferon-beta versus no intervention. One trial (21 participants) compared pegylated interferon-alpha versus no intervention, but it did not provide any data for analysis. One trial (41 participants) compared MTH-68/B vaccine versus no intervention. Two trials (237 participants) compared pegylated interferon-alpha versus pegylated interferon-alpha plus ribavirin. None of the trials compared direct-acting antivirals versus placebo or other interventions. The mean or median follow-up period in the trials ranged from six to 36 months.There was no short-term mortality (less than one year) in any group in any trial except for one trial where one participant died in the pegylated interferon-alpha plus ribavirin group (1/95: 1.1%). In the trials that reported follow-up beyond one year, there were no further deaths. The number of serious adverse events was higher with pegylated interferon-alpha plus ribavirin than with pegylated interferon-alpha (rate ratio 2.74, 95% CI 1.40 to 5.33; participants = 237; trials = 2; I2 = 0%). The proportion of people with any adverse events was higher with interferon-alpha and interferon-beta compared with no intervention (OR 203.00, 95% CI 9.01 to 4574.81; participants = 33; trials = 1 and OR 27.88, 95% CI 1.48 to 526.12; participants = 40; trials = 1). None of the trials reported health-related quality of life, liver transplantation, decompensated liver disease, cirrhosis, or hepatocellular carcinoma. The proportion of people with chronic HCV infection as indicated by the lack of sustained virological response was lower in the interferon-alpha group versus no intervention (OR 0.27, 95% CI 0.09 to 0.76; participants = 99; trials = 3; I2 = 0%). The differences between the groups were imprecise or not estimable (because neither group had any events) for all the remaining comparisons.Four of the 10 trials (40%) received financial or other assistance from pharmaceutical companies who would benefit from the findings of the research; the source of funding was not available in five trials (50%), and one trial (10%) was funded by a hospital. AUTHORS' CONCLUSIONS Very low quality evidence suggests that interferon-alpha may decrease the incidence of chronic HCV infection as measured by sustained virological response. However, the clinical impact such as improvement in health-related quality of life, reduction in cirrhosis, decompensated liver disease, and liver transplantation has not been reported. It is also not clear whether this finding is applicable in the current clinical setting dominated by the use of pegylated interferons and direct-acting antivirals, although we found no evidence to support that pegylated interferons or ribavirin or both are effective in people with acute HCV infection. We could find no randomised trials comparing direct-acting antivirals with placebo or other interventions for acute HCV infection. There is significant uncertainty in the benefits and harms of the interventions, and high-quality randomised clinical trials are required.
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Affiliation(s)
- Maria Kalafateli
- Royal Free Hospital and the UCL Institute of Liver and Digestive HealthSheila Sherlock Liver CentreLondonUK
| | - Elena Buzzetti
- Royal Free Hospital and the UCL Institute of Liver and Digestive HealthSheila Sherlock Liver CentreLondonUK
| | - Douglas Thorburn
- Royal Free Hospital and the UCL Institute of Liver and Digestive HealthSheila Sherlock Liver CentreLondonUK
| | - Brian R Davidson
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryPond StreetLondonUKNW3 2QG
| | - Emmanuel Tsochatzis
- Royal Free Hospital and the UCL Institute of Liver and Digestive HealthSheila Sherlock Liver CentreLondonUK
| | - Kurinchi Selvan Gurusamy
- University College LondonDivision of Surgery and Interventional Science9th Floor, Royal Free HospitalRowland Hill StreetLondonUKNW3 2PF
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13
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Manzardo C, Londoño MC, Castells LL, Testillano M, Luis Montero J, Peñafiel J, Subirana M, Moreno A, Aguilera V, Luisa González-Diéguez M, Calvo-Pulido J, Xiol X, Salcedo M, Cuervas-Mons V, Manuel Sousa J, Suarez F, Serrano T, Ignacio Herrero J, Jiménez M, Fernandez JR, Giménez C, Del Campo S, Esteban-Mur JI, Crespo G, Moreno A, de la Rosa G, Rimola A, Miro JM. Direct-acting antivirals are effective and safe in HCV/HIV-coinfected liver transplant recipients who experience recurrence of hepatitis C: A prospective nationwide cohort study. Am J Transplant 2018; 18:2513-2522. [PMID: 29963780 DOI: 10.1111/ajt.14996] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 06/04/2018] [Accepted: 06/22/2018] [Indexed: 01/25/2023]
Abstract
Direct-acting antivirals have proved to be highly efficacious and safe in monoinfected liver transplant (LT) recipients who experience recurrence of hepatitis C virus (HCV) infection. However, there is a lack of data on effectiveness and tolerability of these regimens in HCV/HIV-coinfected patients who experience recurrence of HCV infection after LT. In this prospective, multicenter cohort study, the outcomes of 47 HCV/HIV-coinfected LT patients who received DAA therapy (with or without ribavirin [RBV]) were compared with those of a matched cohort of 148 HCV-monoinfected LT recipients who received similar treatment. Baseline characteristics were similar in both groups. HCV/HIV-coinfected patients had a median (IQR) CD4 T-cell count of 366 (256-467) cells/µL. HIV-RNA was <50 copies/mL in 96% of patients. The DAA regimens administered were SOF + LDV ± RBV (34%), SOF + SMV ± RBV (31%), SOF + DCV ± RBV (27%), SMV + DCV ± RBV (5%), and 3D (3%), with no differences between the groups. Treatment was well tolerated in both groups. Rates of SVR (negative serum HCV-RNA at 12 weeks after the end of treatment) were high and similar for coinfected and monoinfected patients (95% and 94%, respectively; P = .239). Albeit not significant, a trend toward lower SVR rates among patients with advanced fibrosis (P = .093) and genotype 4 (P = .088) was observed. In conclusion, interferon-free regimens with DAAs for post-LT recurrence of HCV infection in HIV-infected individuals were highly effective and well tolerated, with results comparable to those of HCV-monoinfected patients.
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Affiliation(s)
| | - Maria C Londoño
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - LLuís Castells
- CIBEREHD, Barcelona, Spain.,Liver Unit, Internal Medicine Department, Hospital Vall d'Hebrón, Universitat Autónoma de Barcelona, Barcelona, Spain
| | | | - José Luis Montero
- CIBEREHD, Barcelona, Spain.,Hospital Universitario Reina Sofía-IMIBIC Córdoba, Cordoba, Spain
| | - Judit Peñafiel
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Marta Subirana
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ana Moreno
- Hospital Universitario Ramón y Cajal-IRYCIS, Madrid, Spain
| | | | | | | | - Xavier Xiol
- Hospital de Bellvitge-IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | | | - Trinidad Serrano
- CIBEREHD, Barcelona, Spain.,Hospital Universitario Lozano Blesa, ISS Aragón, Zaragoza, Spain
| | - Jose Ignacio Herrero
- CIBEREHD, Barcelona, Spain.,Clínica Universidad de Navarra, IdiSNA, Pamplona, Spain
| | | | - José R Fernandez
- Servicio de Digestivo, Hospital Universitario Cruces, Barakaldo, Barakaldo
| | | | | | - Juan I Esteban-Mur
- CIBEREHD, Barcelona, Spain.,Liver Unit, Internal Medicine Department, Hospital Vall d'Hebrón, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Gonzalo Crespo
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.,CIBEREHD, Barcelona, Spain
| | - Asunción Moreno
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Antoni Rimola
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.,CIBEREHD, Barcelona, Spain
| | - Jose M Miro
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
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14
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Suda G, Ogawa K, Morikawa K, Sakamoto N. Treatment of hepatitis C in special populations. J Gastroenterol 2018; 53:591-605. [PMID: 29299684 PMCID: PMC5910474 DOI: 10.1007/s00535-017-1427-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 12/19/2017] [Indexed: 02/08/2023]
Abstract
Hepatitis C virus (HCV) infection is one of the primary causes of liver cirrhosis and hepatocellular carcinoma. In hemodialysis patients, the rate of HCV infection is high and is moreover associated with a poor prognosis. In liver transplantation patients with HCV infection, recurrent HCV infection is universal, and re-infected HCV causes rapid progression of liver fibrosis and graft loss. Additionally, in patients with HCV and human immunodeficiency virus (HIV) co-infection, liver fibrosis progresses rapidly. Thus, there is an acute need for prompt treatment of HCV infection in these special populations (i.e., hemodialysis, liver transplantation, HIV co-infection). However, until recently, the standard anti-HCV treatment involved the use of interferon-based therapy. In these special populations, interferon-based therapies could not achieve a high rate of sustained viral response and moreover were associated with a higher rate of adverse events. With the development of novel direct-acting antivirals (DAAs), the landscape of anti-HCV therapy for special populations has changed dramatically. Indeed, in special populations treated with interferon-free DAAs, the sustained viral response rate was above 90%, with a lower incidence and severity of adverse events.
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Affiliation(s)
- Goki Suda
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Koji Ogawa
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Kenichi Morikawa
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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15
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Liao HT, Tan P, Huang JW, Yuan KF. Ledipasvir + Sofosbuvir for Liver Transplant Recipients With Recurrent Hepatitis C: A Systematic Review and Meta-analysis. Transplant Proc 2018; 49:1855-1863. [PMID: 28923637 DOI: 10.1016/j.transproceed.2017.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/15/2017] [Accepted: 04/27/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Studies focusing on the efficacy and safety of ledipasvir (LDV) + sofosbuvir (SOF) therapy in liver transplant (LT) recipients with hepatitis C virus (HCV) recurrence are still limited. Therefore, the aim of our work was to perform a systematic review and meta-analysis to evaluate outcome data of LDV + SOF therapy in LT recipients. METHODS Multiple databases were systematically searched for eligible studies. We included studies reporting sustained virological response 12 weeks after treatment (SVR12) and treatment-related adverse events (AEs) in LT recipients treated with LDV + SOF ± ribavirin (RBV) for HCV recurrence. All statistical analyses were conducted by using R version 3.3.1 (The R Foundation for Statistical Computing, Vienna, Austria). RESULTS Twelve studies with a total of 994 LT recipients were included, most of which were diagnosed with HCV genotype 1 infection. The overall SVR12 reached 96.3% (95% confidence interval [CI]: 94.9%-97.5%) and no significant heterogeneity was observed (Q statistic = 10.63, P = .47; I2 = 0%). No difference was found in SVR12 between treatments for 12 weeks and 24 weeks (P = .18). Patients treated with LDV + SOF + RBV (n = 525) exhibited an SVR12 rate of 95.1% (95% CI 92.8%-96.6%), which showed no difference from the findings in the LDV + SOF treatment group (n = 314) with an SVR12 reaching 94.9% (95% CI 91.5%-97.0%; P = .92). There was a tendency for a higher SVR12 in patients without cirrhosis than those with cirrhosis (P < .05). The most common AEs were listed as following: anemia 41.9% (n = 203 of 484), fatigue 39.1% (n = 207 of 530), headache 24.2% (n = 128 of 530), nausea 21.9% (n = 106 of 484), and diarrhea 19.0% (n = 92 of 484). CONCLUSION LDV + SOF-based treatment is highly effective and well tolerated in LT recipients with HCV reinfection.
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Affiliation(s)
- H-T Liao
- Department of Liver Surgery, Liver Transplantation Division, West China Hospital, Sichuan University, Chengdu, China
| | - P Tan
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - J-W Huang
- Department of Liver Surgery, Liver Transplantation Division, West China Hospital, Sichuan University, Chengdu, China.
| | - K-F Yuan
- Department of Liver Surgery, Liver Transplantation Division, West China Hospital, Sichuan University, Chengdu, China.
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16
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Tronina O, Ślubowska K, Mikołajczyk-Korniak N, Komuda-Leszek E, Wieczorek-Godlewska R, Łągiewska B, Pacholczyk M, Lisik W, Kosieradzki M, Durlik M. Fibrosing Cholestatic Hepatitis C After Liver Transplantation: Therapeutic Options Before and After Introduction of Direct-Acting Antivirals: Our Experience and Literature Review. Transplant Proc 2018; 49:1409-1418. [PMID: 28736015 DOI: 10.1016/j.transproceed.2017.01.077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 01/24/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cirrhosis caused by hepatitis C is the most common indication for liver transplantation. The most aggressive form of hepatitis C virus (HCV) relapse after liver transplantation is fibrosing cholestatic hepatitis C, which can be observed in 2% to 15% of recipients. METHODS Double therapy with peg-interferon and ribavirin was characterized by low antiviral response, rapid fibrosis, and frequent graft failure within 1 year after surgery. RESULTS Introduction of direct-acting antivirals for HCV treatment allows for more efficient therapy with less adverse reactions, including patients with fibrosing cholestatic hepatitis C. CONCLUSIONS We present 4 (2.5%) cases of cholestatic viral hepatitis C recurrence in patients undergoing transplantation between 2006 and 2015 at the Transplantation Institute of Warsaw; during this period, 158 liver transplants were performed in patients with cirrhosis caused by HCV infection.
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Affiliation(s)
- O Tronina
- Department of Transplantation Medicine, Nephrology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
| | - K Ślubowska
- Department of Transplantation Medicine, Nephrology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - N Mikołajczyk-Korniak
- Department of Transplantation Medicine, Nephrology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - E Komuda-Leszek
- Department of Transplantation Medicine, Nephrology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - R Wieczorek-Godlewska
- Department of Transplantation Medicine, Nephrology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - B Łągiewska
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Pacholczyk
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - W Lisik
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Kosieradzki
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Durlik
- Department of Transplantation Medicine, Nephrology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
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17
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Pharmacokinetics of Tacrolimus and Cyclosporine in Liver Transplant Recipients Receiving 3 Direct-Acting Antivirals as Treatment for Hepatitis C Infection. Ther Drug Monit 2017; 38:640-5. [PMID: 27310199 DOI: 10.1097/ftd.0000000000000315] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Interactions between tacrolimus and cyclosporine (CSA) and the 3 direct-acting antiviral regimen (3D) of ombitasvir, paritaprevir/ritonavir, and dasabuvir necessitate a priori dose adjustments for the immunosuppressants to achieve desired levels. Modeling and simulations based on data in healthy subjects predicted that tacrolimus 0.5 mg every 7 days or 0.2 mg every 3 days, and CSA at one-fifth the total daily dose administered once daily, would achieve desired trough concentrations (Ctrough) during 3D treatment. The success of these dosing recommendations was evaluated by analyzing pharmacokinetic data from liver transplant recipients in the CORAL-I study. METHODS A population pharmacokinetic model was developed using tacrolimus dosing and Ctrough data before and during 3D treatment (n = 29). The model was used to simulate various tacrolimus dosing regimens and predict tacrolimus concentration-time profiles during 3D treatment. CSA Ctrough data before and during 3D treatment (n = 5) were also summarized. RESULTS A one-compartment model with first-order absorption adequately described tacrolimus pharmacokinetic profiles during the first 4 weeks of 3D treatment. Estimated tacrolimus Ctrough values (median; interquartile range) before and during 3D treatment were comparable (5.7 ng/mL; 4.9-6.5 ng/mL versus 5.2 ng/mL; 4.2-6.3 ng/mL, respectively). Based on simulations, in a patient with a starting Ctrough of 6 ng/mL, 0.5 mg tacrolimus every 7 or 14 days or 0.2 mg tacrolimus every 3 days will result in Ctrough levels of 6-9 ng/mL, 4-6 ng/mL, and 6-10 ng/mL, respectively, during 3D treatment. For CSA, Ctrough values (median; interquartile range) before and during 3D treatment were comparable (126 ng/mL; 94-140 ng/mL versus 104 ng/mL; 82-140 ng/mL). CONCLUSIONS Observed data for tacrolimus and CSA in liver transplant recipients confirm that the recommended dosing strategies are valid and therapeutic levels of immunosuppression can be maintained during 3D treatment.
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18
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Teegen EM, Globke B, Schott E, Pratschke J, Eurich D. A Closing Chapter: Hepatitis C Genotype 3 Elimination in Liver Transplant; Sofosbuvir/Daclatasvir in a Hard-to-Treat Population. EXP CLIN TRANSPLANT 2017; 16:61-67. [PMID: 29137590 DOI: 10.6002/ect.2016.0296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Historically, hepatitis C virus genotype 3 infection has not been as hard to treat as genotype 1 using interferon-based therapy. Now, genotype 3 infection can be treated using interferon-free regimes such as the combination of sofosbuvir and daclatasvir, which is a highly successful and reliable therapeutic option before liver transplant. However, real world data are rather limited regarding the use of antivirals (sofosbuvir/daclatasvir) for hepatitis C virus genotype 3 recurrence after liver transplant. Here, we present the results of antiviral treatment with sofosbuvir and daclatasvir in patients with genotype 3 recurrence after liver transplant and also viewed published data, to finally close the chapter on genotype 3 elimination. MATERIALS AND METHODS We analyzed 11 patients who received liver transplants due to hepatitis C virus genotype 3-associated cirrhosis at our center. Two patients were nadve for any antiviral therapy. All patients received antiviral treatment with sofosbuvir/daclatasvir for 12 weeks after liver transplant, with 1 patient also having ribavirin. The endpoint was hepatitis C virus RNA-free survival after 12 weeks of therapy. Secondary endpoints were preservation of renal and liver function and incidence of adverse events. RESULTS All patients were free of hepatitis C virus RNA by at least 8 weeks after therapy initiation. Elevated transaminases and gamma-glutamyltransferase at the beginning of therapy normalized quickly during treatment. Synthesis and excretion were stable at all dates. Patients displayed no severe adverse effects, especially regarding renal function and blood counts. Sustained virologic response rates at week 12 were achieved in all 11 patients. CONCLUSIONS Hepatitis C virus could be eliminated in all patients after liver transplant with 12-week sofosbuvir/daclatasvir therapy. Sofosbuvir combined with daclatasvir is safe and reliable for recurrent hepatitis C virus genotype 3 infection. Our results have closed the chapter on genotype 3 recurrence after liver transplant in our outpatient clinic.
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Affiliation(s)
- Eva Maria Teegen
- From the Department of Surgery, Charité-Universitätsmedizin Berlin, Germany
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19
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Dharancy S, Coilly A, Fougerou-Leurent C, Duvoux C, Kamar N, Leroy V, Tran A, Houssel-Debry P, Canva V, Moreno C, Conti F, Dumortier J, Di Martino V, Radenne S, De Ledinghen V, D'Alteroche L, Silvain C, Besch C, Perré P, Botta-Fridlund D, Francoz C, Habersetzer F, Montialoux H, Abergel A, Debette-Gratien M, Rohel A, Rossignol E, Samuel D, Duclos-Vallée JC, Pageaux GP. Direct-acting antiviral agent-based regimen for HCV recurrence after combined liver-kidney transplantation: Results from the ANRS CO23 CUPILT study. Am J Transplant 2017; 17:2869-2878. [PMID: 28898563 DOI: 10.1111/ajt.14490] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 08/16/2017] [Accepted: 08/20/2017] [Indexed: 01/25/2023]
Abstract
Hepatitis C virus (HCV) infection is associated with reduced patient survival following combined liver-kidney transplantation (LKT). The aim of this study was to assess the efficacy and safety of second-generation direct-acting antivirals (DAAs) in this difficult-to-treat population. The ANRS CO23 "Compassionate use of Protease Inhibitors in Viral C Liver Transplantation" (CUPILT) study is a prospective cohort including transplant recipients with recurrent HCV infection treated with DAAs. The present work focused on recipients with recurrent infection following LKT. The study population included 23 patients. All patients received at least one NS5B inhibitor (sofosbuvir) in their antiviral regimen an average of 90 months after LKT. Ninety-six percent of recipients achieved a sustained virological response (SVR) at week 12 (SVR12). In terms of tolerance, 39% of recipients presented with at least one serious adverse event. None of the patients experienced acute rejection during therapy and there were no deaths during follow-up. The glomerular filtration rate (GFR) decreased significantly from baseline to the end of therapy. However, this study did not show that the decline in GFR persisted over time or that it was directly related to DAAs. The DAA-based regimen is well tolerated with excellent results in terms of efficacy. It will become the gold standard for the treatment of recurrent HCV following LKT.
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Affiliation(s)
- Sébastien Dharancy
- CHRU Lille, Hepatology Unit, Claude Huriez Hospital, CHRU Lille, Lille, France
| | - Audrey Coilly
- Hepatobiliary Center, AP-HP Paul Brousse Hospital, Villejuif, France.,Paris Sud University, Paris Sud Saclay University, UMR-S 1193, Villejuif, France.,INSERM, Unité 1193, Villejuif, France.,DHU Hepatinov, Villejuif, France
| | - Claire Fougerou-Leurent
- INSERM, CIC 1414 Clinical Investigation Center, Rennes, France.,Pharmacology Unit, CHU Rennes, Rennes, France
| | | | - Nassim Kamar
- Nephrology and Organ Transplantation Unit, CHU Rangueil, INSERM U1043, IFR-BMT, Paul Sabatier University, Toulouse, France
| | - Vincent Leroy
- Hepato-Gastroenterolgy Unit, Pôle Digidune, CHU Grenoble, Grenoble, France
| | - Albert Tran
- Hepatogastroenterology Unit, Nice University Hospital, INSERM, U1065, Equipe 8, Nice Sophia Antipolis University, Faculty of Medicine, Nice, Cedex 2, France
| | - Pauline Houssel-Debry
- Hepatology and Liver Transplant Unit, Pontchaillou University Hospital, Rennes, France
| | - Valérie Canva
- CHRU Lille, Hepatology Unit, Claude Huriez Hospital, CHRU Lille, Lille, France
| | - Christophe Moreno
- Hepatogastroenterology Unit, CUB Hôpital Erasme, Brussels University, Bruxelles, Belgique
| | - Filoména Conti
- Hepatology and Liver Transplant Unit, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Jérome Dumortier
- Liver Transplant Unit, Digestive Diseases Federation, Edouard Herriot Hospital, Hospices Civils de Lyon Université Claude Bernard Lyon 1, Lyon, France
| | - Vincent Di Martino
- Hepatology Unit, CHRU Jean Minjoz Franche Comté University, Besançon, France
| | - Sylvie Radenne
- Hepatology Unit, HCL, Hôpital de la Croix-Rousse, Lyon, France
| | - Victor De Ledinghen
- Hepatogastroenterology Unit, Haut Leveque Hospital, CHU Bordeaux & INSERM U1053, Bordeaux, France
| | | | | | - Camille Besch
- Liver Transplant and Digestive Surgery Unit, Strasbourg University, Strasbourg, France
| | - Philippe Perré
- Infectious Diseases Unit, CHD Vendée, La Roche sur Yon, France
| | | | - Claire Francoz
- Hepatology Unit, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - François Habersetzer
- Universitary Hospitals of Strasbourg, Inserm U 1110, LabEx HepSYS, Strasbourg University, Strasbourg, France
| | | | - Armand Abergel
- Hepatogastroenterology Unit, CHU Estaing Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Alexandra Rohel
- Unité de recherche Clinique et Fondamentale sur les Hépatites Virales, ANRS (France REcherche Nord&sud Sida-hiv Hépatites), Paris, France
| | - Emilie Rossignol
- INSERM, CIC 1414 Clinical Investigation Center, Rennes, France.,Pharmacology Unit, CHU Rennes, Rennes, France
| | - Didier Samuel
- Hepatobiliary Center, AP-HP Paul Brousse Hospital, Villejuif, France.,Paris Sud University, Paris Sud Saclay University, UMR-S 1193, Villejuif, France.,INSERM, Unité 1193, Villejuif, France.,DHU Hepatinov, Villejuif, France
| | - Jean-Charles Duclos-Vallée
- Hepatobiliary Center, AP-HP Paul Brousse Hospital, Villejuif, France.,Paris Sud University, Paris Sud Saclay University, UMR-S 1193, Villejuif, France.,INSERM, Unité 1193, Villejuif, France.,DHU Hepatinov, Villejuif, France
| | - Georges-Philippe Pageaux
- Liver transplant and Hepatogastroenterology Unit, CHU Saint-Eloi, Montpellier University, Montpellier, France
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20
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Anand AC, Agarwal SK, Garg HK, Khanna S, Gupta S. Sofosbuvir and Ribavirin for 24 Weeks Is An Effective Treatment Option for Recurrent Hepatitis C Infection After Living Donor Liver Transplantation. J Clin Exp Hepatol 2017; 7:165-171. [PMID: 28970701 PMCID: PMC5620355 DOI: 10.1016/j.jceh.2017.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 06/19/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recurrent hepatitis C virus (HCV) has been a serious problem after liver transplantation (LT). We report our experience of 24-week therapy with sofosbuvir (SOF) and ribavirin (RBV) in post-LT recurrent HCV in living donor liver transplantation (LDLT) setting in South Asia. METHODS Data from all patients treated for post-transplantation HCV recurrence in a single center were analyzed. Treatment regimen was 24 weeks of SOF 400 mg daily and RBV (starting at 800 mg daily, increased as tolerated). Sustained virological response (SVR) was assessed 12 weeks and 24 weeks after completion of treatment. RESULTS 63 patients (median age 52 [range 30-69] years; 80% males) were treated. Most (76.2%) were treatment experienced and predominant HCV genotype was 3 (77.7%) followed by 1 (20.6%). Median transient elastography (Fibroscan) score was 7 (range 3-11) kPa and none of the patients had cirrhosis. SVR12 was achieved in 60 of 63 patients (95.2%) while SVR24 was noted in 59 (93.7%). SVR12 rates were as good in genotype-3 as in genotype-1. Older age, longer period after transplantation, higher Fibroscan value and higher need for erythropoietin were likely to be associated with relapse. Adverse effects were noted in 34 patients and weakness and fatigue were the commonest side effects. Significant drop in hemoglobin (<8 g/dL) was seen in 6 patients. CONCLUSIONS SOF + RBV combination therapy for 24 weeks was safe and effective in treatment of for post-LT recurrent HCV in a single LT center and remains relevant due to its low cost and lack of drug interactions.
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Key Words
- CBC, complete blood counts
- DAA, directly acting antivirals
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- Hb%, hemoglobin
- KFT, kidney function tests
- LDLT, living donor liver transplantation
- LFT, liver function tests
- LT, liver transplantation
- RBV, ribavirin
- SOF, sofosbuvir
- SVR, sustained virological response
- g/dL, grams per decilitre
- genotype-1
- genotype-3
- kPA, kilo pascals
- living donor liver transplantation
- recurrent hepatitis C
- sustained viral response
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Affiliation(s)
- Anil C. Anand
- Department of Hepatology & Gastroenterology, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, New Delhi 110076, India
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Salcedo M, Prieto M, Castells L, Pascasio JM, Montero Alvarez JL, Fernández I, Sánchez-Antolín G, González-Diéguez L, García-Gonzalez M, Otero A, Lorente S, Espinosa MD, Testillano M, González A, Castellote J, Casafont F, Londoño MC, Pons JA, Molina Pérez E, Cuervas-Mons V, Pascual S, Herrero JI, Narváez I, Vinaixa C, Llaneras J, Sousa JM, Bañares R. Efficacy and safety of daclatasvir-based antiviral therapy in hepatitis C virus recurrence after liver transplantation. Role of cirrhosis and genotype 3. A multicenter cohort study. Transpl Int 2017; 30:1041-1050. [PMID: 28608619 DOI: 10.1111/tri.12999] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/22/2017] [Accepted: 06/22/2017] [Indexed: 12/17/2022]
Abstract
Direct-acting antiviral agents (DAA) combining daclatasvir (DCV) have reported good outcomes in the recurrence of hepatitis C virus (HCV) infection after liver transplant (LT). However, its effect on the severe recurrence and the risk of death remains controversial. We evaluated the efficacy, predictors of survival, and safety of DAC-based regimens in a large real-world cohort. A total of 331 patients received DCV-based therapy. Duration of therapy and ribavirin use were at the investigator's discretion. The primary end point was sustained virological response (SVR) at week 12. A multivariate analysis of predictive factors of mortality was performed. Intention-to-treat (ITT) and per-protocol SVR were 93.05% and 96.9%. ITT-SVR was lower in cirrhosis (n = 163) (96.4% vs. 89.6% P = 0.017); the SVR in genotype 3 (n = 91) was similar, even in advanced fibrosis (96.7% vs. 88%, P = 0.2). Ten patients (3%) experienced virological failure. Therapy was stopped in 18 patients (5.44%), and ten died during treatment. A total of 22 patients (6.6%) died. Albumin (HR = 0.376; 95% CI 0.155-0.910) and baseline MELD (HR = 1.137; 95% CI: 1.061-1.218) were predictors of death. DCV-based DAA treatment is efficacious and safe in patients with HCV infection after LT. Baseline MELD score and serum albumin are predictors of survival irrespective of viral response.
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Affiliation(s)
- Magdalena Salcedo
- Liver Transplant Unit and Digestive Disease Department, IISGM, CIBERehd, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Martín Prieto
- Liver Unit, Gastroenterology Department, CIBERehd, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Lluís Castells
- Liver Unit, Internal Medicine Department, CIBERehd, Hospital General Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Manuel Pascasio
- UGC Digestive Diseases, CIBERehd, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | - Gloria Sánchez-Antolín
- Liver Unit, Liver Transplantation Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
| | | | | | - Alejandra Otero
- Liver Unit, Hospital Universitario de A Coruña, A Coruña, Spain
| | - Sara Lorente
- Digestive Diseases Department, Hospital Clínico Lozano Blesa de Zaragoza, IIS Aragón, Zaragoza, Spain
| | - Maria Dolores Espinosa
- Liver Unit, UGC Digestive Diseases, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Milagros Testillano
- Liver Unit and Liver transplantation, Hospital Universitario de Cruces, Bilbao, Spain
| | - Antonio González
- Liver Unit, Hospital Universitario Ntra. Sra. de Candelaria, Tenerife, Spain
| | - Jose Castellote
- Digestive Disease Department, IDIBELL, Hospital Universitari de Bellvitge, Universidad de Barcelona, Barcelona, Spain
| | - Fernando Casafont
- Gastroenterology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Jose Antonio Pons
- Liver Unit, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Esther Molina Pérez
- Abdominal Transplants Unit, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Valentín Cuervas-Mons
- Liver Transplant Unit, Department of Medicine, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
| | - Sonia Pascual
- Liver Unit, Gastroenterology Department, CIBERehd, Hospital General Universitario de Alicante, Alicante, Spain
| | - Jose Ignacio Herrero
- Liver Unit, Instituto de Investigación Sanitaria de Navarra (IdiSNA), CIBERehd, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Isidoro Narváez
- Liver Transplantation Unit, Gastroenterology Department, Complejo Hospitalario Universitario de Badajoz, "Infanta Cristina", Badajoz, Spain
| | - Carmen Vinaixa
- Gastroenterology Department, CIBERehd, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Jordi Llaneras
- Liver Unit, Internal Medicine Department, Hospital General Vall Hebrón, Barcelona, Spain
| | - Jose Manuel Sousa
- UGC Unit, Digestive Diseases, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Rafael Bañares
- Liver Transplant Unit and Digestive Disease Department, Facultad de Medicina Universidad Complutense, IISGM, CIBERehd, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Sofosbuvir-Based Antiviral Therapy Is Highly Effective In Recurrent Hepatitis C in Liver Transplant Recipients: Canadian Multicenter "Real-Life" Experience. Transplantation 2017; 100:1059-65. [PMID: 26950722 DOI: 10.1097/tp.0000000000001126] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND This study evaluates the efficacy, safety, and tolerability of regimens containing sofosbuvir (SOF) in the treatment of hepatitis C virus (HCV) recurrence in all genotypes in patients outside of clinical trials in all Canadian transplant centers. METHODS One hundred twenty liver transplantation recipients from across Canada with HCV recurrence were started on SOF-based regimens (SOF + simeprevir ± ribavirin (RBV), n = 53; SOF + pegylated interferon + RBV, n = 25; SOF + RBV, n = 36; and SOF + ledipasvir, n = 6) between January and November 2014. Mean age 58 ± 6.85 years, majority (83%) were genotype 1, male (81%), and treatment experienced (82%). Twenty-seven percent had fibrosing cholestatic hepatitis/early aggressive HCV in the graft, and 48% had F3/4 fibrosis. The primary outcomes included patient and graft survival, on- and end-of-treatment response and sustained virological response at 12 weeks after treatment end (SVR12), and adverse events. RESULTS One hundred thirteen of 120 (94%) patients were HCV RNA undetectable at end of treatment, and SVR12 was achieved in 102/120 (85%) patients, with 7 relapses, 1 nonresponder, and 10 deaths (liver-related complications). Sixty-three percent had HCV RNA levels below the lower limit of quantification at week 4. Serum creatinine levels remained stable throughout the treatment. Severe anemia occurred in 13% of patients, primarily in RBV-based regimens. CONCLUSIONS Sofosbuvir-based antiviral therapy for HCV recurrence after liver transplantation was well tolerated, with an overall high SVR12 rate (85%) including patients with severe disease recurrence and F3-4 cirrhosis. The response rate was higher (91%) in mild HCV recurrence, suggesting earlier treatment might be beneficial.
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Liao H, Tan P, Zhu Z, Yan X, Huang J. Sofosbuvir in combination with daclatasvir in liver transplant recipients with HCV infection: A systematic review and meta-analysis. Clin Res Hepatol Gastroenterol 2017; 41:262-271. [PMID: 28082137 DOI: 10.1016/j.clinre.2016.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 11/23/2016] [Accepted: 12/06/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Studies focusing on the efficacy of SOF+DCV regimen on liver transplantation recipients with HCV infection are still limited. In the current study, we aimed to perform a systematic review and meta-analysis to evaluate the efficacy and tolerability of SOF+DCV regimen, with or without ribavirin, on post-LT setting. METHODS A systematic literature search of various databases as well as abstracts of major liver diseases conferences was performed. Studies with SVR data in HCV infected liver transplantation recipients treated with daclatasvir/sofosbuvir regimen were included. All statistical analyses were conducted by R version 3.3.1 (The R Foundation for Statistical Computing, Vienna, Austria). RESULTS Seven studies with a total of 379 LT recipients were included in this study. Most of these LT recipients had genotype 1 HCV infection. The overall rate of SVR12 reached 93.3% (95% CI: 83.3% to 99.4%). After excluding the study of Fontana et al., the SVR12 reached 96.8% and heterogeneity was lowered down (P=0.17). In three studies, patients treated with SOF+DCV (n=146) had a higher SVR12 rate than that of patients treated with SOF+DCV+RBV (n=83) (OR 0.33, 95% CI: 0.12 to 0.87; P=0.02). There was no difference in SVR12 between patients infected with HCV genotype 1 and genotype 3 (P=0.57) and no difference was found in SVR12 rate between 12-week therapy and 24-week therapy (P=0.82). The most common adverse effects (AEs) were: anemia 32% (n=64/202), infections 26% (n=38/149), neutropenia 23% (n=35/149), thrombocytopenia 21% (n=32/149) and renal failure 8% (n=12/149). CONCLUSION SOF+DCV±RBV regimen is of high efficacy and tolerability in LT recipients with HCV infection.
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Affiliation(s)
- Haotian Liao
- Department of Liver Surgery, Liver Transplantation Division, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ping Tan
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zexin Zhu
- Department of Liver Surgery, Liver Transplantation Division, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiaokai Yan
- Department of Liver Surgery, Liver Transplantation Division, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jiwei Huang
- Department of Liver Surgery, Liver Transplantation Division, West China Hospital, Sichuan University, Chengdu 610041, China.
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24
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Toshikuni N. Therapy with Direct-Acting Antiviral Agents for Hepatitis C-Related Liver Cirrhosis. Gut Liver 2017; 11:335-348. [PMID: 27840363 PMCID: PMC5417775 DOI: 10.5009/gnl15458] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 10/27/2015] [Accepted: 12/11/2015] [Indexed: 12/23/2022] Open
Abstract
Chronic hepatitis C virus (HCV) infection may eventually lead to liver cirrhosis (LC), a condition associated with a high risk of liver failure and hepatocellular carcinoma. Although interferon (IFN)-based therapy has made substantial contributions to the management of HCV-infected patients, this therapy has limitations for LC patients in terms of eligibility, tolerability, relatively low and high rates of sustained virological response (SVR), and serious adverse events. Therapy with newly developed direct-acting antiviral agents (DAAs) can overcome these limitations in IFN-based therapy. Recent phase 3 trials have demonstrated that DAA therapy achieved high SVR rates (more than 90% for genotype 1; 80% to 90% for genotype 2; 60% to 70% for genotype 3) for compensated LC patients, with high tolerability and relatively low rates of serious adverse events. Furthermore, trials have suggested that DAA therapy can be used for the treatment of decompensated LC patients as well as pretransplant and posttransplant LC patients. In this article, we review the current status of DAA therapy for HCV-related LC patients.
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25
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Little EC, Berenguer M. The New Era of Hepatitis C: Therapy in Liver Transplant Recipients. Clin Liver Dis 2017; 21:421-434. [PMID: 28364822 DOI: 10.1016/j.cld.2016.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hepatitis C virus (HCV) is the leading cause of end-stage liver disease in both Europe and the United States and is the most common reason for liver transplant. In the absence of antiviral therapy, recurrent infection is the norm with subsequent graft hepatitis and impaired survival. Whether it may be better to postpone therapy in patients in whom higher risk of failure and toxicity is coupled with lower chance of liver function improvement likely depends on several factors, including waiting time, center allocation policy, presence of hepatocellular carcinoma and local prevalence of anti-HCV-positive donors.
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Affiliation(s)
- Ester Coelho Little
- Banner Transplant Institute, 1441 North 12th Street, Second floor, Phoenix, AZ 85006, USA; Banner University Medical Center Phoenix, Phoenix, AZ, USA
| | - Marina Berenguer
- Servicio de Medicina Digestivo (Torre F-5), La Fe University Hospital, Ciberehd*, University of Valencia, Avda Fernando Abril Martorell n 106, Valencia 46026, Spain.
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26
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Abstract
Cirrhosis due to chronic hepatitis C (HCV) is the leading indication for liver transplantation in North America and Europe. HCV re-infection post-transplant is nearly universal and if left untreated negatively affects patient and graft survival. Until recently, treatment options for HCV were limited to interferon (IFN)-based therapies which had low sustained viral response (SVR) rates and were poorly tolerated in the post-transplant setting. In the last 3 years, the promise of the directly acting antivirals (DAAs) for the treatment of HCV has been fulfilled with high sustained viral response (SVR) rates and a low side effect profile demonstrated in both registration trials and real-world studies. This innovation has allowed post-liver transplant patients with HCV recurrence access to interferon-free therapies with extraordinary efficacy, safety, tolerability, and fewer drug-drug interactions.
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Yang Y, Dang SS. Safety of direct antiviral agents for treatment of hepatitis C virus infection. Shijie Huaren Xiaohua Zazhi 2017; 25:659-669. [DOI: 10.11569/wcjd.v25.i8.659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Antiviral drugs for treatment of hepatitis C have grown dramatically in recent years. The emergence of direct antiviral agents (DAAs) is a major advance in hepatitis C treatment. Since the first generation DAAs appeared in 2011, two more generations of DAAs have been approved by the Food and Drug Administration in only five years. With the advantages of coverage of all genotypes, high availability and easy administration, DAAs have been widely used worldwide in recent years. DAAs have nearly solved the main problems encountered in hepatitis C antiviral therapy. However, adverse events associated with DAAs use have been reported constantly, and the safety of DAAs has attracted more and more attention. According to recent reports, the adverse reactions of DAAs have been gradually reduced from the first generation to the third generation. When combined with other drugs, the drug-drug interactions (DDIs) need special attention. In addition, the usage of DAAs in special patient groups should be cautious. In this paper, we will summarize the adverse effects and DDIs of DAAs as well as their usage in the general population and special patient groups.
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28
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Kalafateli M, Buzzetti E, Thorburn D, Davidson BR, Tsochatzis E, Gurusamy KS. Pharmacological interventions for acute hepatitis C infection: an attempted network meta-analysis. Cochrane Database Syst Rev 2017; 3:CD011644. [PMID: 28285495 PMCID: PMC6464698 DOI: 10.1002/14651858.cd011644.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) is a single-stranded RNA (ribonucleic acid) virus that has the potential to cause inflammation of the liver. The traditional definition of acute HCV infection is the first six months following infection with the virus. Another commonly used definition of acute HCV infection is the absence of HCV antibody and subsequent seroconversion (presence of HCV antibody in a person who was previously negative for HCV antibody). Approximately 40% to 95% of people with acute HCV infection develop chronic HCV infection, that is, have persistent HCV RNA in their blood. In 2010, an estimated 160 million people worldwide (2% to 3% of the world's population) had chronic HCV infection. The optimal pharmacological treatment of acute HCV remains controversial. Chronic HCV infection can damage the liver. OBJECTIVES To assess the comparative benefits and harms of different pharmacological interventions in the treatment of acute HCV infection through a network meta-analysis and to generate rankings of the available pharmacological treatments according to their safety and efficacy. However, it was not possible to assess whether the potential effect modifiers were similar across different comparisons. Therefore, we did not perform the network meta-analysis, and instead, we assessed the comparative benefits and harms of different interventions versus each other or versus no intervention using standard Cochrane methodology. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Science Citation Index Expanded, World Health Organization International Clinical Trials Registry Platform, and randomised controlled trials registers to April 2016 to identify randomised clinical trials on pharmacological interventions for acute HCV infection. SELECTION CRITERIA We included only randomised clinical trials (irrespective of language, blinding, or publication status) in participants with acute HCV infection. We excluded trials which included previously liver transplanted participants and those with other coexisting viral diseases. We considered any of the various pharmacological interventions compared with placebo or each other. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We calculated the odds ratio (OR) and rate ratio with 95% confidence intervals (CI) using both fixed-effect and random-effects models based on the available-participant analysis with Review Manager 5. We assessed risk of bias according to Cochrane, controlled risk of random errors with Trial Sequential Analysis, and assessed the quality of the evidence using GRADE. MAIN RESULTS We identified 10 randomised clinical trials with 488 randomised participants that met our inclusion criteria. All the trials were at high risk of bias in one or more domains. Overall, the evidence for all the outcomes was very low quality evidence. Nine trials (467 participants) provided information for one or more outcomes. Three trials (99 participants) compared interferon-alpha versus no intervention. Three trials (90 participants) compared interferon-beta versus no intervention. One trial (21 participants) compared pegylated interferon-alpha versus no intervention, but it did not provide any data for analysis. One trial (41 participants) compared MTH-68/B vaccine versus no intervention. Two trials (237 participants) compared pegylated interferon-alpha versus pegylated interferon-alpha plus ribavirin. None of the trials compared direct-acting antivirals versus placebo or other interventions. The mean or median follow-up period in the trials ranged from six to 36 months.There was no short-term mortality (less than one year) in any group in any trial except for one trial where one participant died in the pegylated interferon-alpha plus ribavirin group (1/95: 1.1%). In the trials that reported follow-up beyond one year, there were no further deaths. The number of serious adverse events was higher with pegylated interferon-alpha plus ribavirin than with pegylated interferon-alpha (rate ratio 2.74, 95% CI 1.40 to 5.33; participants = 237; trials = 2; I2 = 0%). The proportion of people with any adverse events was higher with interferon-alpha and interferon-beta compared with no intervention (OR 203.00, 95% CI 9.01 to 4574.81; participants = 33; trials = 1 and OR 27.88, 95% CI 1.48 to 526.12; participants = 40; trials = 1). None of the trials reported health-related quality of life, liver transplantation, decompensated liver disease, cirrhosis, or hepatocellular carcinoma. The proportion of people with chronic HCV infection as indicated by the lack of sustained virological response was lower in the interferon-alpha group versus no intervention (OR 0.27, 95% CI 0.09 to 0.76; participants = 99; trials = 3; I2 = 0%). The differences between the groups were imprecise or not estimable (because neither group had any events) for all the remaining comparisons.Four of the 10 trials (40%) received financial or other assistance from pharmaceutical companies who would benefit from the findings of the research; the source of funding was not available in five trials (50%), and one trial (10%) was funded by a hospital. AUTHORS' CONCLUSIONS Very low quality evidence suggests that interferon-alpha may decrease the incidence of chronic HCV infection as measured by sustained virological response. However, the clinical impact such as improvement in health-related quality of life, reduction in cirrhosis, decompensated liver disease, and liver transplantation has not been reported. It is also not clear whether this finding is applicable in the current clinical setting dominated by the use of pegylated interferons and direct-acting antivirals, although we found no evidence to support that pegylated interferons or ribavirin or both are effective in people with acute HCV infection. We could find no randomised trials comparing direct-acting antivirals with placebo or other interventions for acute HCV infection. There is significant uncertainty in the benefits and harms of the interventions, and high-quality randomised clinical trials are required.
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Affiliation(s)
- Maria Kalafateli
- Royal Free Hospital and the UCL Institute of Liver and Digestive HealthSheila Sherlock Liver CentreLondonUK
| | - Elena Buzzetti
- Royal Free Hospital and the UCL Institute of Liver and Digestive HealthSheila Sherlock Liver CentreLondonUK
| | - Douglas Thorburn
- Royal Free Hospital and the UCL Institute of Liver and Digestive HealthSheila Sherlock Liver CentreLondonUK
| | - Brian R Davidson
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryPond StreetLondonUKNW3 2QG
| | - Emmanuel Tsochatzis
- Royal Free Hospital and the UCL Institute of Liver and Digestive HealthSheila Sherlock Liver CentreLondonUK
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29
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Bowring MG, Kucirka LM, Massie AB, Luo X, Cameron A, Sulkowski M, Rakestraw K, Gurakar A, Kuo I, Segev DL, Durand CM. Changes in Utilization and Discard of Hepatitis C-Infected Donor Livers in the Recent Era. Am J Transplant 2017; 17:519-527. [PMID: 27456927 PMCID: PMC5266634 DOI: 10.1111/ajt.13976] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 07/12/2016] [Indexed: 01/25/2023]
Abstract
The impact of interferon (IFN)-free direct-acting antiviral (DAA) hepatitis C virus (HCV) treatments on utilization and outcomes associated with HCV-positive deceased donor liver transplantation (DDLT) is largely unknown. Using the Scientific Registry of Transplant Recipients, we identified 25 566 HCV-positive DDLT recipients from 2005 to 2015 and compared practices according to the introduction of DAA therapies using modified Poisson regression. The proportion of HCV-positive recipients who received HCV-positive livers increased from 6.9% in 2010 to 16.9% in 2015. HCV-positive recipients were 61% more likely to receive an HCV-positive liver after 2010 (early DAA/IFN era) (aRR:1.45 1.611.79 , p < 0.001) and almost three times more likely to receive one after 2013 (IFN-free DAA era) (aRR:2.58 2.853.16 , p < 0.001). Compared to HCV-negative livers, HCV-positive livers were 3 times more likely to be discarded from 2005 to 2010 (aRR:2.69 2.993.34 , p < 0.001), 2.2 times more likely after 2010 (aRR:1.80 2.162.58 , p < 0.001) and 1.7 times more likely after 2013 (aRR:1.37 1.682.04 , p < 0.001). Donor HCV status was not associated with increased risk of all-cause graft loss (p = 0.1), and this did not change over time (p = 0.8). Use of HCV-positive livers has increased dramatically, coinciding with the advent of DAAs. However, the discard rate remains nearly double that of HCV-negative livers. Further optimization of HCV-positive liver utilization is necessary to improve access for all candidates.
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Affiliation(s)
- Mary G Bowring
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lauren M Kucirka
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore MD
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore MD
| | - Xun Luo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrew Cameron
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mark Sulkowski
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Katie Rakestraw
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ahmet Gurakar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Irene Kuo
- Department of Epidemiology and Biostatistics, George Washington University School of Public Health, Washington, DC
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore MD,Scientific Registry of Transplant Recipients, Minneapolis, MN
| | - Christine M Durand
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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30
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Ganesh S, Almazroo OA, Tevar A, Humar A, Venkataramanan R. Drug Metabolism, Drug Interactions, and Drug-Induced Liver Injury in Living Donor Liver Transplant Patients. Clin Liver Dis 2017; 21:181-196. [PMID: 27842771 DOI: 10.1016/j.cld.2016.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Living donor liver transplant (LDLT) fills a critically needed gap in the number of livers available for transplant. However, little is known about the functional recovery of the liver in the donor and in the recipient after surgery. Given that both donor and recipients are treated with several drugs, it is important to characterize the time course of recovery of hepatic synthetic, metabolic, and excretory function in these patients. In the absence of data from LDLT, information on the effect of liver disease on the pharmacokinetics of medications can be used as guidance for drug dosing in LDLT patients.
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Affiliation(s)
- Swaytha Ganesh
- Thomas Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA.
| | - Omar Abdulhameed Almazroo
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, 731 Salk Hall, 3501 Terrace Street, Pittsburgh, PA 15261, USA
| | - Amit Tevar
- Thomas Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Abhinav Humar
- Thomas Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA.
| | - Raman Venkataramanan
- Thomas Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA; Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, 718 Salk Hall, 3501 Terrace Street, Pittsburgh, PA 15261, USA; Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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O'Leary JG, Fontana RJ, Brown K, Burton JR, Firpi-Morell R, Muir A, O'Brien C, Rabinovitz M, Reddy R, Ryan R, Shprecher A, Villadiego S, Prabhakar A, Brown RS. Efficacy and safety of simeprevir and sofosbuvir with and without ribavirin in subjects with recurrent genotype 1 hepatitis C postorthotopic liver transplant: the randomized GALAXY study. Transpl Int 2017; 30:196-208. [PMID: 27896858 DOI: 10.1111/tri.12896] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/05/2016] [Accepted: 11/25/2016] [Indexed: 12/14/2022]
Abstract
This prospective, randomized, phase 2 study in subjects with recurrent hepatitis C virus (HCV) genotype 1 postorthotopic liver transplant evaluated once-daily simeprevir 150 mg + sofosbuvir 400 mg, with and without ribavirin 1000 mg. Primary endpoint was proportion of subjects with week 12 sustained virologic response (SVR12). Thirty-three subjects without cirrhosis were randomized 1:1:1 into three arms (stratified by genotype/subtype and Q80K): Arm 1, simeprevir + sofosbuvir + ribavirin, 12 weeks; Arm 2, simeprevir + sofosbuvir, 12 weeks; Arm 3, simeprevir + sofosbuvir, 24 weeks; 13 additional subjects (two with cirrhosis, 11 without cirrhosis) entered Arm 3. All 46 subjects received at least one dose of study drug; median age, 60 years; 73.9% male; 80.4% White; 71.7% genotype/subtype 1a [12 (36.4%) of these had Q80K]; median 4.5 years post-transplant. Among randomized subjects, SVR12 was achieved by 81.8% in Arm 1, 100% in Arm 2, and 93.9% in Arm 3; two subjects did not achieve SVR12: one viral relapse (follow-up week 4; Arm 1) and one missing follow-up week 12 data. In total, five subjects had a serious adverse event, considered unrelated to treatment per investigator. Simeprevir exposure was increased relative to the nontransplant setting, but not considered clinically relevant. Simeprevir + sofosbuvir treatment, with or without ribavirin, was efficacious and well tolerated (ClinicalTrials.gov Identifier: NCT02165189).
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Affiliation(s)
| | - Robert J Fontana
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kimberly Brown
- Department of Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - James R Burton
- Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | | | - Andrew Muir
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Christopher O'Brien
- Department of Medicine, University of Miami School of Medicine, Miami, FL, USA
| | | | - Rajender Reddy
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Ryan
- Janssen Research & Development, Titusville, NJ, USA
| | | | | | | | - Robert S Brown
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
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32
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Shoreibah M, Orr J, Jones D, Zhang J, Venkata K, Massoud O. Ledipasvir/sofosbuvir without ribavirin is effective in the treatment of recurrent hepatitis C virus infection post-liver transplant. Hepatol Int 2017; 11:434-439. [PMID: 28083718 DOI: 10.1007/s12072-016-9778-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/09/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND/AIM Recurrent hepatitis C virus infection is a challenging complication post-liver transplant. Current guidelines recommend the combination of ribavirin and ledipasvir/sofosbuvir for 12 weeks for the treatment of recurrent HCV genotype 1 post-liver transplant. Data are limited on the use of ledipasvir/sofosbuvir without ribavirin. The aim of this study was to evaluate the use of ledipasvir/sofosbuvir without ribavirin for the treatment of recurrent hepatitis C virus post-liver transplant. METHODS This is a retrospective study of liver transplant patients who received ledipasvir/sofosbuvir without ribavirin for the treatment of recurrent hepatitis C virus in our liver center from 2014 to 2016. RESULTS A total of 60 patients were enrolled of which 70% were male, 88% Caucasian, age 60 ± 7 years, 15% cirrhotic, and 45% treatment-experienced with recurrent hepatitis C virus infection genotype 1 post-liver transplant. Treatment duration varied from 8 to 24 weeks. There were no serious adverse events and no discontinuation of treatment. A total of 71% of patients had undetectable serum hepatitis C virus at 4 weeks. However, irrespective of treatment duration, 100% of patients had undetectable serum hepatitis C virus at the end of treatment and 100% of patients achieved sustained viral response at 12 weeks. CONCLUSION Ledipasvir/sofosbuvir without ribavirin is an effective treatment of recurrent hepatitis C virus infection post-liver transplant. The entire group achieved sustained viral response at 12 weeks irrespective of the length of treatment. The combination of ledipasvir/sofosbuvir was well tolerated without serious adverse effects or discontinuation.
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Affiliation(s)
- Mohamed Shoreibah
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, 1808 7th Ave South, BDB 391, Birmingham, AL, 5294, USA
| | - Jordan Orr
- Department of Internal Medicine, Tinsley Harrison Internal Medicine Residency Program, University of Alabama at Birmingham, 1720 2nd Ave South, BDB 327, Birmingham, AL, 35294, USA.
| | - DeAnn Jones
- The University of Alabama at Birmingham, 1802 6th Ave South, Birmingham, 35233, AL, USA
| | - Jie Zhang
- The University of Alabama at Birmingham, 1802 6th Ave South, Birmingham, 35233, AL, USA
| | - Krishna Venkata
- Department of Medicine, Montgomery Internal Medicine Residency Program, University of Alabama at Birmingham, 2055 E. South Blvd., Suite 200, Montgomery, 36116, AL, USA
| | - Omar Massoud
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, 1808 7th Ave South, BDB 391, Birmingham, AL, 5294, USA
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33
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McCarty TR, Lim JK. Developing therapies to treat hepatitis C infection in post-liver transplant recipients. Expert Opin Pharmacother 2017; 18:165-174. [PMID: 28024124 DOI: 10.1080/14656566.2016.1276564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Currently, hepatitis C virus (HCV) infection remains the most common indication for liver transplant in the United States (US) with almost universal HCV recurrence in the post-liver transplant setting. Previous interferon (IFN)-related efficacy and tolerability concerns about worsening liver function have limited treatment options for many patients with HCV-associated decompensated liver disease and post-liver transplant recipients. However, the last decade has seen a seen a radical shift in the management of HCV with multiple direct-acting antiviral (DAA) treatments that provide more effective, all-oral, IFN-free alternatives. Areas covered: This review will serve to highlight the various pharmacotherapies available to clinicians for patients with HCV recurrence post-liver transplant. A brief history of prior regimens is provided with evidence for newer treatments presented. Also detailed are updated guidelines from societal organizations. Finally, timing of HCV treatment is discussed as the decision to treat patients in a pre or post-liver transplant setting remains challenging. Expert opinion: While there are many potential available therapies for HCV recurrence in the post-liver transplant setting, daclatasvir/sofosbuvir and ledipasvir/sofosbuvir have been the most extensively studied. Newer, pangenotypic generation drugs require more evidence before routine utilization in post-liver transplant recipients.
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Affiliation(s)
- Thomas R McCarty
- a Department of Internal Medicine , Yale University School of Medicine , New Haven , CT , USA
| | - Joseph K Lim
- b Section of Digestive Diseases , Yale University School of Medicine , New Haven , CT , USA
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Martini S, Sacco M, Strona S, Arese D, Tandoi F, Dell Olio D, Stradella D, Cocchis D, Mirabella S, Rizza G, Magistroni P, Moschini P, Ottobrelli A, Amoroso A, Rizzetto M, Salizzoni M, Saracco GM, Romagnoli R. Impact of viral eradication with sofosbuvir-based therapy on the outcome of post-transplant hepatitis C with severe fibrosis. Liver Int 2017; 37:62-70. [PMID: 27344058 DOI: 10.1111/liv.13193] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/23/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Several studies have shown that new direct-acting antivirals maintain their efficacy in liver transplant (LT) recipients with severe hepatitis C virus (HCV) recurrence. We determined the clinical impact of sofosbuvir/ribavirin in LT through the changes in liver function and fibrosis state at 24 and 48 weeks after treatment. METHODS Between June 2014 and July 2015, 126 patients (30 F3, 96 F4 Metavir stage) were enrolled to receive sofosbuvir + ribavirin (24 weeks, 118 patients) or sofosbuvir + simeprevir + ribavirin (12 weeks, 8 patients); treatment was initiated at a median time of 4.3 years from LT. Median follow-up after therapy completion was 461 days. RESULTS All 30 F3 patients achieved a sustained virological response at week 24 after treatment (SVR24) and showed a distinct amelioration of the AST-to-platelet ratio index (APRI), FIB-4 and liver stiffness at elastography by week 24 post-therapy, which were maintained at week 48. Of the 96 F4 cirrhotic patients, 72 (75%) achieved SVR24 accompanied by significant improvement of liver function, which was maintained at week 48 (Child B-C 22% baseline, 11% week 24, 7% week 48); APRI, FIB-4 and liver stiffness further improved significantly between weeks 24 and 48 of follow-up. Among the 77 responders (27 F3, 50 F4) who underwent elastography at baseline and at the end of follow-up, 39 (50.6%; 18 F3, 21 F4) exhibited a regression in fibrosis stage. CONCLUSION At about 1 year from the completion of successful sofosbuvir-based therapy, patients with post-LT HCV and severe fibrosis experienced a long-term liver function improvement accompanied by a regression of fibrosis stage in half of them.
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Affiliation(s)
- Silvia Martini
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Marco Sacco
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Silvia Strona
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Daniele Arese
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Francesco Tandoi
- Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Dominic Dell Olio
- Regional Transplantation Center, Piedmont, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Davide Stradella
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Donatella Cocchis
- Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Stefano Mirabella
- Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Giorgia Rizza
- Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Paola Magistroni
- Regional Transplantation Center, Piedmont, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Pamela Moschini
- Regional Transplantation Center, Piedmont, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Antonio Ottobrelli
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Antonio Amoroso
- Regional Transplantation Center, Piedmont, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Mario Rizzetto
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Mauro Salizzoni
- Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Giorgio M Saracco
- Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Renato Romagnoli
- Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
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Ueda Y, Ikegami T, Soyama A, Akamatsu N, Shinoda M, Ishiyama K, Honda M, Marubashi S, Okajima H, Yoshizumi T, Eguchi S, Kokudo N, Kitagawa Y, Ohdan H, Inomata Y, Nagano H, Shirabe K, Uemoto S, Maehara Y. Simeprevir or telaprevir with peginterferon and ribavirin for recurrent hepatitis C after living-donor liver transplantation: A Japanese multicenter experience. Hepatol Res 2016; 46:1285-1293. [PMID: 26899352 DOI: 10.1111/hepr.12684] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 02/10/2016] [Accepted: 02/12/2016] [Indexed: 02/08/2023]
Abstract
AIM This study aimed to clarify the efficacy and safety of simeprevir, a second-generation NS3/4A inhibitor, with peginterferon and ribavirin for recurrent hepatitis C after liver transplantation. METHODS A retrospective cohort study of living-donor liver transplant recipients with recurrent hepatitis C with the hepatitis C virus genotype 1 treated with either simeprevir- or telaprevir-based triple therapy was carried out at eight Japanese liver transplant centers. RESULTS Simeprevir- and telaprevir-based triple therapies were given to 79 and 36 patients, respectively. Of the 79 patients treated with simeprevir-based triple therapy, 44 (56%) achieved sustained virological response 12 weeks (SVR12) after treatment ended, and there was no significant difference in the SVR12 between the simeprevir- and telaprevir-based triple therapy groups (69%). The rates of adverse events were not significantly different between the simeprevir- and telaprevir-based triple therapy groups, although the rate of patients who received blood cell transfusion and erythropoietin due to anemia and had renal insufficiency were significantly higher in the telaprevir group than in the simeprevir group. Three baseline factors, the presence of prior dual therapy with peginterferon and ribavirin (P = 0.001), a non-responder to the prior dual therapy (P < 0.001), and male sex (P = 0.040), were identified as significant predictive factors for non-SVR with simeprevir-based triple therapy. CONCLUSION Simeprevir-based triple therapy for recurrent hepatitis C after living-donor liver transplantation resulted in a high SVR rate and good tolerability, especially in treatment-naïve patients.
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Affiliation(s)
- Yoshihide Ueda
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University
| | - Toru Ikegami
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Akihiko Soyama
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
| | - Nobuhisa Akamatsu
- Division of Artificial Organ and Transplantation, Department of Surgery, University of Tokyo
| | - Masahiro Shinoda
- Department of Surgery, Keio University School of Medicine, Tokyo
| | - Kohei Ishiyama
- Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masaki Honda
- Department of Transplantation and Pediatric Surgery, Kumamoto University, Kumamoto
| | - Shigeru Marubashi
- Department of Surgery, Osaka University Graduate School of Medicine, Osaka
| | - Hideaki Okajima
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
| | - Norihiro Kokudo
- Division of Artificial Organ and Transplantation, Department of Surgery, University of Tokyo
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo
| | - Hideki Ohdan
- Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukihiro Inomata
- Department of Transplantation and Pediatric Surgery, Kumamoto University, Kumamoto
| | - Hiroaki Nagano
- Department of Surgery, Osaka University Graduate School of Medicine, Osaka
| | - Ken Shirabe
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Shinji Uemoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka
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36
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Rubin RA, Russo MW, Brown KA, Fontana RJ, Levitsky J, Vargas H, Yoshida EM, Brown RS. Twice-Daily Telaprevir for Posttransplant Genotype 1 Hepatitis C Virus: A Prospective Safety, Efficacy, and Pharmacokinetics Study. EXP CLIN TRANSPLANT 2016; 16:182-190. [PMID: 27855589 DOI: 10.6002/ect.2016.0251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Our objective was to determine the safety, efficacy, and pharmacokinetics of telaprevir plus pegylated interferon alfa 2a and ribavirin for chronic, posttransplant genotype 1 hepatitis C virus infection. MATERIALS AND METHODS A prospective, single-arm, multicenter, open-label, phase 2b study was conducted at 22 North American sites to assess the safety, efficacy, and pharmacokinetics of pegylated interferon alfa 2a, ribavirin, and twice daily telaprevir in liver transplant recipients with recurrent, chronic hepatitis C without cirrhosis. Baseline liver biopsies were read by a central pathologist. There were planned safety reviews after a sentinel cohort reached treatment weeks 4 and 16. Serial pharmacokinetic sampling was performed for calcineurin inhibitors, telaprevir, and ribavirin. RESULTS Sixty-one patients were enrolled and received ≥ 1 dose of study medication; 37 (61%) achieved sustained virologic response. Thirteen of 18 treatment-naive patients (72%), 10 of 11 patients with no or minimal fibrosis (91%), 13 of 15 patients (87%) with interleukin 28B genotype CC, and 36 of 45 patients (80%) with either undetectable or unquantifiable hepatitis C virus RNA at treatment week 4 achieved sustained virologic response. Nine patients (15%) had ≥ 1 drug-related serious adverse event and 7 (11%) discontinued all study drugs due to an adverse event. There were no deaths or acute cellular rejection episodes. During telaprevir treatment, median doses of tacrolimus and cyclosporine were 0.5 mg weekly and 25 mg daily. Target exposures were achieved for telaprevir with twice daily dosing and for ribavirin with reduced initial dosing. CONCLUSIONS Telaprevir combination therapy for posttransplant hepatitis C virus infection yielded superior efficacy than historical controls. Adverse events were similar to, but exceeded, those in immunocompetent patients. Calcineurin inhibitor dosing levels were substantially reduced with telaprevir.
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Affiliation(s)
- Raymond A Rubin
- From the Piedmont Transplant Institute, Piedmont Hospital, Atlanta, Georgia, USA
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37
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Coilly A, Fougerou-Leurent C, de Ledinghen V, Houssel-Debry P, Duvoux C, Di Martino V, Radenne S, Kamar N, D'Alteroche L, Leroy V, Canva V, Lebray P, Moreno C, Dumortier J, Silvain C, Besch C, Perre P, Botta-Fridlund D, Anty R, Francoz C, Abergel A, Debette-Gratien M, Conti F, Habersetzer F, Rohel A, Rossignol E, Danjou H, Roque-Afonso AM, Samuel D, Duclos-Vallée JC, Pageaux GP. Multicentre experience using daclatasvir and sofosbuvir to treat hepatitis C recurrence - The ANRS CUPILT study. J Hepatol 2016; 65:711-718. [PMID: 27262758 DOI: 10.1016/j.jhep.2016.05.039] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 05/19/2016] [Accepted: 05/23/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS HCV recurrence remains a major issue in the liver transplant field, as it has a negative impact on both graft and patient survival. The purpose of this study was to investigate the efficacy and safety of treating HCV recurrence with sofosbuvir (SOF) and daclatasvir (DCV) combination therapy. METHODS From October 2013 to March 2015, 559 liver recipients were enrolled in the prospective multicentre France REcherche Nord&Sud Sida-hiv Hépatites (ANRS) Compassionate use of Protease Inhibitors in viral C Liver Transplantation cohort. We selected 137 patients with an HCV recurrence receiving SOF and DCV, whatever the genotype or fibrosis stage. The use of ribavirin and the duration of therapy were at the investigator's discretion. The primary efficacy end point was a sustained virological response (SVR) 12weeks after the end of treatment. RESULTS The SVR rate 12weeks after completing treatment was 96% under the intention-to treat analysis and 99% when excluding non-virological failures. Only two patients experienced a virological failure. The serious adverse event (SAE) rate reached 17.5%. Four patients (3%) stopped their treatment prematurely because of SAEs. Anaemia was the most common AE, with significantly more cases in the ribavirin group (56% vs. 18%; p<0.0001). A slight but significant reduction in creatinine clearance was reported. No clinically relevant drug-drug interactions were noted, but 52% of patients required a change to the dosage of immunosuppressive drugs. CONCLUSIONS Treatment with SOF plus DCV was associated with a high SVR12 and low rates of serious adverse events among liver recipients with HCV recurrence. LAY SUMMARY The recurrence of hepatitis C used to be the first cause of graft failure in infected liver transplanted recipients. Our study demonstrates the great efficacy of one combination of new all-oral direct-acting antiviral, sofosbuvir and daclatasvir, to treat the recurrence of hepatitis C on the graft. Ninety-six per cent of recipients were cured. The safety profile of this combination seemed to be good, especially no relevant drug-drug interaction with immunosuppressive drugs.
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Affiliation(s)
- Audrey Coilly
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif F-94800, France; Université Paris Sud, Université Paris Sud-Saclay, UMR-S 1193, Villejuif F-94800, France; INSERM, Unité 1193, Villejuif F-94800, France; DHU Hepatinov, Villejuif F-94800, France.
| | - Claire Fougerou-Leurent
- Hôpital Universitaire de Pontchaillou, Service de Pharmacologie, Rennes, France; INSERM, CIC 1414 Clinical Investigation Centre, Rennes, France
| | - Victor de Ledinghen
- Service d'Hépato-Gastroentérologie, Hôpital Haut-Lévêque, CHU Bordeaux, & INSERM U1053, Bordeaux, France
| | - Pauline Houssel-Debry
- Hôpital Universitaire de Pontchaillou, Service d'Hépatologie et Transplantation Hépatique, Rennes, France
| | - Christophe Duvoux
- Service d'Hépatologie, Hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - Vincent Di Martino
- Service d'Hépatologie, CHRU Jean Minjoz et Université de Franche-Comté, Besançon, France
| | - Sylvie Radenne
- Service d'Hépatologie, HCL, Hôpital de la Croix-Rousse, 69205 Lyon, France
| | - Nassim Kamar
- Département de Néphrologie et Transplantation d'Organes, CHU Rangueil, INSERM U1043, IFR-BMT, Université Paul Sabatier, Toulouse, France
| | | | - Vincent Leroy
- Clinique Universitaire d'Hépato-Gastroentérologie, Pôle Digidune, CHU de Grenoble, France
| | - Valérie Canva
- CHRU de Lille, Service d'Hépatologie, Hôpital Huriez, CHRU Lille, 59037 Lille, France
| | - Pascal Lebray
- Service d'Hépatologie et de Transplantation Hépatique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Christophe Moreno
- Département de Gastroenterologie, d'Hépatopancréatologie et Cancérologie Digestive, CUB Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Jérôme Dumortier
- Unité de Transplantation Hépatique, Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon et Université Claude Bernard Lyon 1, Lyon, France
| | | | - Camille Besch
- Centre de Chirurgie Digestive et Transplantation Hépatique, Université de Strasbourg, France
| | - Philippe Perre
- Service de MPU Infectiologie CHD Vendée, 85925 La Roche sur Yon, France
| | | | - Rodolphe Anty
- Hôpital universitaire de Nice, Service d'Hépato-gastroentérologie, INSERM, U1065, Equipe 8, Université de Nice-Sophia-Antipolis, Faculté de Médecine, Nice F-06107, Cedex 2, France
| | - Claire Francoz
- Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Armando Abergel
- Service d'Hépato-gastroentérologie, CHU Estaing Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Filomena Conti
- Service d'Hépatologie et de Transplantation Hépatique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - François Habersetzer
- Hôpitaux Universitaires de Strasbourg, Inserm U 1110, LabEx HepSYS, Université de Strasbourg, Strasbourg, France
| | - Alexandra Rohel
- Unité de recherché Clinique et Fondamentale sur les Hépatites Virales, Agence Nationale de Recherche sur le Sida et les Hépatites Virales, Paris, France
| | - Emilie Rossignol
- Hôpital Universitaire de Pontchaillou, Service de Pharmacologie, Rennes, France; INSERM, CIC 1414 Clinical Investigation Centre, Rennes, France
| | - Hélène Danjou
- Hôpital Universitaire de Pontchaillou, Service de Pharmacologie, Rennes, France; INSERM, CIC 1414 Clinical Investigation Centre, Rennes, France
| | - Anne-Marie Roque-Afonso
- AP-HP Hôpital Paul-Brousse, Service de Virologie, Villejuif F-94800, France; Université Paris Sud, Université Paris Sud-Saclay, UMR-S 1193, Villejuif F-94800, France; INSERM, Unité 1193, Villejuif F-94800, France; DHU Hepatinov, Villejuif F-94800, France
| | - Didier Samuel
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif F-94800, France; Université Paris Sud, Université Paris Sud-Saclay, UMR-S 1193, Villejuif F-94800, France; INSERM, Unité 1193, Villejuif F-94800, France; DHU Hepatinov, Villejuif F-94800, France
| | - Jean-Charles Duclos-Vallée
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif F-94800, France; Université Paris Sud, Université Paris Sud-Saclay, UMR-S 1193, Villejuif F-94800, France; INSERM, Unité 1193, Villejuif F-94800, France; DHU Hepatinov, Villejuif F-94800, France
| | - Georges-Philippe Pageaux
- Département d'Hépato-gastroentérologie et de Transplantation Hépatique, CHU Saint-Eloi, Université de Montpellier, Montpellier F-34295, France
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Dumortier J, Leroy V, Duvoux C, de Ledinghen V, Francoz C, Houssel-Debry P, Radenne S, d'Alteroche L, Fougerou-Leurent C, Canva V, di Martino V, Conti F, Kamar N, Moreno C, Lebray P, Tran A, Besch C, Diallo A, Rohel A, Rossignol E, Abergel A, Botta-Fridlund D, Coilly A, Samuel D, Duclos-Vallée JC, Pageaux GP. Sofosbuvir-based treatment of hepatitis C with severe fibrosis (METAVIR F3/F4) after liver transplantation. Liver Transpl 2016; 22:1367-78. [PMID: 27348086 DOI: 10.1002/lt.24505] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/24/2016] [Accepted: 05/31/2016] [Indexed: 12/12/2022]
Abstract
Recurrence of hepatitis C virus (HCV) after liver transplantation (LT) can rapidly lead to liver graft cirrhosis and, therefore, graft failure and retransplantation or death. The aim of the present study was to assess efficacy and tolerance of sofosbuvir (SOF)-based regimens for the treatment of HCV recurrence in patients with severe fibrosis after LT. The Compassionate Use of Protease Inhibitors in Viral C Liver Transplantation (CULPIT) study is a prospective multicenter cohort including patients with HCV recurrence following LT treated with second generation direct antivirals. The present study focused on patients included between October 2013 and November 2014 and diagnosed with HCV recurrence and liver graft extensive fibrosis (METAVIR F3/F4). A SOF-based regimen was administered to 125 patients fulfilling inclusion criteria. The median delay from LT was 95.9 ± 69.6 months. The characteristics of patients were as follows: mean age, 59.4 ± 9.0 years; 78.4% male; infected by HCV genotype 1: 78.2%, mean HCV RNA: 6.1 ± 1.0 log10 IU/mL. Eighty patients had failed previous post-LT antiviral therapy (64.0%) including triple therapy with first generation protease inhibitors in 19 (15.2%) patients. The main combination regimen was SOF/daclatasvir (73.6%). Ribavirin was used in 60 patients. Sustained virological response 12 weeks after treatment was 92.8% (on an intention-to-treat basis); 7 patients with virological failure were observed. Serious adverse events occurred in 25.6% of the patients during antiviral treatment. During antiviral treatment and follow-up, 3 patients were retransplanted and 4 patients died. In conclusion, SOF-based antiviral treatment shows very promising results in patients with HCV recurrence and severe fibrosis after LT. Liver Transplantation 22 1367-1378 2016 AASLD.
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Affiliation(s)
- Jérôme Dumortier
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, Lyon, France.
| | - Vincent Leroy
- Pôle Digidune, Clinique Universitaire d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire de Grenoble, INSERM/Université Grenoble Alpes U823, Institut Albert Bonniot, Grenoble, France
| | | | - Victor de Ledinghen
- Service d'Hépatologie, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, INSERM U1053, Université Bordeaux, Bordeaux, France
| | - Claire Francoz
- Service d'Hépatologie, Hôpital Beaujon, AP-HP, Université Paris Diderot et INSERM U1149, Centre de Recherche sur l'Inflammation, Clichy, France
| | - Pauline Houssel-Debry
- Service des Maladies du Foie, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Sylvie Radenne
- Service d'Hépatologie, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Louis d'Alteroche
- Service d'hépato-gastroentérologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Claire Fougerou-Leurent
- Unité de Pharmacologie Clinique, Centre Hospitalier Universitaire de Rennes, Centre d'Investigation Clinique INSERM 1414, Rennes, France
| | - Valérie Canva
- Services Maladies de l'Appareil Digestif, Hôpital Claude Huriez, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Vincent di Martino
- Service d'Hépatologie, Hôpital Jean Minjoz, Centre Hospitalier Universitaire de Besançon, Université de Franche Comté, Besançon, France
| | - Filomena Conti
- Service d'hépato-gastroentérologie, Groupe Hospitalier Pitié-Salpétrière, AP-HP, Université Pierre et Marie Curie Paris 6, INSERM Unités Mixtes de Recherche S938, Paris, France
| | - Nassim Kamar
- Département de Néphrologie et de Transplantation d'Organes, Centre Hospitalier Universitaire Rangueil, Université de Toulouse, Toulouse, France
| | - Christophe Moreno
- Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Pascal Lebray
- Service d'hépato-gastroentérologie, Groupe Hospitalier Pitié-Salpétrière, AP-HP, Université Pierre et Marie Curie Paris 6, INSERM Unités Mixtes de Recherche S938, Paris, France
| | - Albert Tran
- Service d'Hépatologie, Hôpital de l'Archet 2, Centre Hospitalier Universitaire de Nice, INSERM U1065, Université de Nice-Sophia-Antipolis, Nice, France
| | - Camille Besch
- Service de Transplantation, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Alpha Diallo
- Unit for Basic and Clinical Research on Viral Hepatitis, France Recherche Nord&Sud Sida-HIV Hépatites, Agence Nationale de Recherche sur le Sida, Paris, France
| | - Alexandra Rohel
- Unit for Basic and Clinical Research on Viral Hepatitis, France Recherche Nord&Sud Sida-HIV Hépatites, Agence Nationale de Recherche sur le Sida, Paris, France
| | - Emilie Rossignol
- Unité de Pharmacologie Clinique, Centre Hospitalier Universitaire de Rennes, Centre d'Investigation Clinique INSERM 1414, Rennes, France
| | - Armand Abergel
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire Estaing, Université d'Auvergne, Unités Mixtes de Recherche CNRS 6284, Clermont-Ferrand, France
| | | | - Audrey Coilly
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Université Paris-Sud, Université Paris-Saclay, UMR-S 1193, INSERM Unité 1193, Département Hospitalo-Universitaire Hepatinov, Villejuif, France
| | - Didier Samuel
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Université Paris-Sud, Université Paris-Saclay, UMR-S 1193, INSERM Unité 1193, Département Hospitalo-Universitaire Hepatinov, Villejuif, France
| | - Jean-Charles Duclos-Vallée
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Université Paris-Sud, Université Paris-Saclay, UMR-S 1193, INSERM Unité 1193, Département Hospitalo-Universitaire Hepatinov, Villejuif, France
| | - Georges-Philippe Pageaux
- Département d'Hépato-Gastroentérologie et de Transplantation Hépatique, Centre Hospitalier Universitaire Saint-Eloi, Université de Montpellier, Montpellier, France
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Shiba H, Hashimoto K, Kelly D, Fujiki M, Quintini C, Aucejo F, Uso TD, Yerian L, Yanaga K, Matsushima M, Eghtesad B, Fung J, Miller C. Risk stratification of allograft failure secondary to hepatitis C recurrence after liver transplantation. Hepatol Res 2016; 46:1099-1106. [PMID: 26833562 DOI: 10.1111/hepr.12661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 01/06/2016] [Accepted: 01/22/2016] [Indexed: 12/24/2022]
Abstract
AIM Hepatitis C virus (HCV) recurrence after liver transplantation decreases survival rates. Improved understanding of the multiple factors influencing HCV recurrence could aid decision-making for donor-recipient pairing and maximize transplant outcomes. The aim of this study was to create a model based on pretransplant variables to stratify patients at risk of HCV-related allograft failure. METHODS This retrospective study enrolled 154 liver transplant recipients with HCV at Cleveland Clinic. RESULTS Among the study population, 54 recipients (35.1%) experienced HCV recurrence, histologically defined as moderate to severe hepatitis and/or bridging fibrosis to cirrhosis. The multivariate analysis found donor age (≥60 years, P < 0.002), donor body mass index (≥30 kg/m2 , P < 0.05), African American recipient (P < 0.01) and genotype 1 (P < 0.02) as risk factors for HCV-related allograft failure. When these four factors were scored as a combined index (no factor [n = 15], one factor [n = 76], two factors [n = 43] and three or more factors [n = 20]), the HCV recurrence-free survival showed good stratification according to the scores: 93.3% with no factor, 79.3% with one factor, 52.0% with two factors and 24.4% with three or more factors at 3 years after transplant (P < 0.0001). Moreover, this risk index also identified the patient group at high risk of HCV recurrence after acute rejection. CONCLUSION While the introduction of direct-acting antiviral agents has been changing the paradigm of HCV treatment, the natural history of recipients with HCV as shown in this study would help estimate the risk of HCV-related allograft failure in those who do not tolerate such new treatment.
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Affiliation(s)
- Hiroaki Shiba
- Department of General Surgery, Digestive Disease Institute.,Department of Hepatobiliary Surgery
| | - Koji Hashimoto
- Department of General Surgery, Digestive Disease Institute.
| | - Dympna Kelly
- Department of General Surgery, Digestive Disease Institute
| | - Masato Fujiki
- Department of General Surgery, Digestive Disease Institute
| | | | | | | | - Lisa Yerian
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Masato Matsushima
- Division of Clinical Research and Development, Jikei University School of Medicine, Tokyo, Japan
| | - Bijan Eghtesad
- Department of General Surgery, Digestive Disease Institute
| | - John Fung
- Department of General Surgery, Digestive Disease Institute
| | - Charles Miller
- Department of General Surgery, Digestive Disease Institute
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Romagnoli R, Martini S, Tandoi F, Dell Olio D, Magistroni P, Bertinetto FE, Dametto E, Rizzetto M, Salizzoni M, Amoroso A. Early reduced liver graft survival in hepatitis C recipients identified by two combined genetic markers. Transpl Int 2016; 29:1070-84. [PMID: 27172242 DOI: 10.1111/tri.12795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 02/23/2016] [Accepted: 05/09/2016] [Indexed: 01/08/2023]
Abstract
HLA and IL-28B genes were independently associated with severity of HCV-related liver disease. We investigated the effects of these combined genetic factors on post-transplant survival in HCV-infected recipients, aiming to provide new data to define the optimal timing of novel antiviral therapies in the transplant setting. HLA-A/B/DRB1 alleles and IL-28B rs12979860 (C > T) polymorphism frequencies were determined in 449 HCV viremic recipients and in their donors. Median follow-up was 10 years; study outcome was graft survival. HLA-DRB1*11 phenotype and IL-28B C/C genotype were significantly less frequent in recipients than donors (27.8% vs. 45.9% and 27.4% vs. 44.9%, respectively, P < 0.00001). Ten-year graft survival was better in patients with HLA-DRB1*11 (P = 0.0183) or IL-28B C/C (P = 0.0436). Conversely, concomitant absence of HLA-DRB1*11 and IL-28B C/C in 228 (50.8%) predicted worse survival (P = 0.0006), which was already evident at the first post-transplant year (P = 0.0370). In multivariable Cox analysis, absence of both markers ranked second as risk factor for survival (HR = 1.74), following donor age ≥ 70 years (HR = 1.77). In the current era of direct-acting antiviral agents, the negative effects of this common immunogenetic profile in HCV-infected recipients could be most effectively neutralized by peri-transplant treatment. This should be particularly relevant in countries where elderly donors represent an unavoidable resource.
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Affiliation(s)
- Renato Romagnoli
- Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Silvia Martini
- Liver Transplantation Center, Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Francesco Tandoi
- Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Dominic Dell Olio
- Regional Transplantation Center - Piedmont, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Paola Magistroni
- Regional Transplantation Center - Piedmont, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
- Immunogenetics Laboratory, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Francesca E Bertinetto
- Regional Transplantation Center - Piedmont, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
- Immunogenetics Laboratory, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Ennia Dametto
- Regional Transplantation Center - Piedmont, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
- Immunogenetics Laboratory, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Mario Rizzetto
- Liver Transplantation Center, Gastrohepatology Unit, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Mauro Salizzoni
- Liver Transplantation Center, General Surgery Unit 2U, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Antonio Amoroso
- Regional Transplantation Center - Piedmont, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
- Immunogenetics Laboratory, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
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41
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Optimum timing of treatment for hepatitis C infection relative to liver transplantation. Lancet Gastroenterol Hepatol 2016; 1:165-172. [PMID: 28404073 DOI: 10.1016/s2468-1253(16)30008-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 12/19/2022]
Abstract
The approval of direct-acting antiviral agents that may be given orally in an interferon-free regimen has greatly changed the landscape of treatment for hepatitis C virus (HCV) infection, especially for patients with the most severe disease, who have decompensated cirrhosis, or who are waiting for or have undergone liver transplantation. Treatment with interferon proved to be ineffective and poorly tolerated because of high risks of infection and transplant rejection. The availability of new drugs poses new questions about the optimum time to give treatment to prevent HCV recurrence, taking into account efficacy, tolerance, and drug-drug interactions. Treatment is acceptable before and after transplantation, but the two strategies have subtle differences. In this Review, we present the available data on the treatment of HCV infection before and after transplantation, and discuss new challenges for practice.
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42
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Londoño MC, Manzardo C, Rimola A, Ruiz P, Costa J, Forner A, Ambrosioni J, Agüero F, Laguno M, Lligoña A, Moreno A, Miró JM. IFN-free therapy for HIV/HCV-coinfected patients within the liver transplant setting. J Antimicrob Chemother 2016; 71:3195-3201. [PMID: 27402009 DOI: 10.1093/jac/dkw270] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 05/17/2016] [Accepted: 06/01/2016] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES IFN-based therapy against hepatitis C recurrence after liver transplantation (LT) has poor effectiveness and tolerability. In HIV/HCV-coinfected liver transplant recipients, the results are even poorer. Here, we report our experience using direct antiviral agents (DAAs) in 11 consecutive coinfected patients within the LT setting. METHODS Four patients with compensated cirrhosis and hepatocellular carcinoma were treated while awaiting LT and seven patients received antiviral therapy due to severe hepatitis C recurrence after LT [fibrosing cholestatic hepatitis (n = 1), fibrosis stage ≥F3 (n = 2) and decompensated cirrhosis (n = 4)]. Patients were treated with different sofosbuvir-based regimens with or without ribavirin for 12 or 24 weeks. RESULTS Sustained virological response (SVR) was achieved in all patients. Two of the four patients treated while awaiting LT reached the time of transplant with undetectable HCV-RNA that remained undetectable 12 weeks after LT, one patient had detectable HCV-RNA at the time of transplant but achieved SVR after completing 12 weeks of therapy after LT and the last patient is still on the waiting list. Seven patients with severe post-LT hepatitis C recurrence were treated within 11-120 months after LT. In these patients, viral eradication was associated with an improvement in liver function and clinical decompensation. Tolerance to antiviral therapy was good and only four patients reported mild adverse events. CONCLUSIONS IFN-free regimens are effective and well tolerated in HIV/HCV-coinfected patients within the LT setting, but more data are needed to confirm our promising results and to establish the best treatment option in this population.
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Affiliation(s)
- Maria-Carlota Londoño
- Liver Unit, Hospital Clínic Barcelona, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Christian Manzardo
- Infectious Disease Service, Hospital Clínic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Antoni Rimola
- Liver Unit, Hospital Clínic Barcelona, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Pablo Ruiz
- Liver Unit, Hospital Clínic Barcelona, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Josep Costa
- Microbiology Service (CDB), Hospital Clínic Barcelona, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alejandro Forner
- Liver Unit, Hospital Clínic Barcelona, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Juan Ambrosioni
- Infectious Disease Service, Hospital Clínic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Fernando Agüero
- Infectious Disease Service, Hospital Clínic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Montserrat Laguno
- Infectious Disease Service, Hospital Clínic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Anna Lligoña
- Addictive Behavior Unit, Hospital Clínic Barcelona, Barcelona, Spain
| | - Asunción Moreno
- Infectious Disease Service, Hospital Clínic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jose-Maria Miró
- Infectious Disease Service, Hospital Clínic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
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Felmlee DJ, Coilly A, Chung RT, Samuel D, Baumert TF. New perspectives for preventing hepatitis C virus liver graft infection. THE LANCET. INFECTIOUS DISEASES 2016; 16:735-745. [PMID: 27301929 PMCID: PMC4911897 DOI: 10.1016/s1473-3099(16)00120-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 01/29/2016] [Accepted: 02/15/2016] [Indexed: 02/07/2023]
Abstract
Hepatitis C virus (HCV) infection is a leading cause of end-stage liver disease that necessitates liver transplantation. The incidence of virus-induced cirrhosis and hepatocellular carcinoma continues to increase, making liver transplantation increasingly common. Infection of the engrafted liver is universal and accelerates progression to advanced liver disease, with 20-30% of patients having cirrhosis within 5 years of transplantation. Treatments of chronic HCV infection have improved dramatically, albeit with remaining challenges of failure and access, and therapeutic options to prevent graft infection during liver transplantation are emerging. Developments in directed use of new direct-acting antiviral agents (DAAs) to eliminate circulating HCV before or after transplantation in the past 5 years provide renewed hope for prevention and treatment of liver graft infection. Identification of the ideal regimen and use of DAAs reveals new ways to treat this specific population of patients. Complementing DAAs, viral entry inhibitors have been shown to prevent liver graft infection in animal models and delay graft infection in clinical trials, which shows their potential for use concomitant to transplantation. We review the challenges and pathology associated with HCV liver graft infection, highlight current and future strategies of DAA treatment timing, and discuss the potential role of entry inhibitors that might be used synergistically with DAAs to prevent or treat graft infection.
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Affiliation(s)
- Daniel J Felmlee
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Strasbourg, France; Université de Strasbourg, Strasbourg, France; Hepatology Research Group, Peninsula School of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Audrey Coilly
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France; University Paris-Sud, UMR-S 1193, Villejuif, France; Inserm Unit 1193, Villejuif F-94800, France
| | - Raymond T Chung
- Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Didier Samuel
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France; University Paris-Sud, UMR-S 1193, Villejuif, France; Inserm Unit 1193, Villejuif F-94800, France.
| | - Thomas F Baumert
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Strasbourg, France; Université de Strasbourg, Strasbourg, France; Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Institut Hospitalo-Universitaire, Pôle Hépato-digestif, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
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Miuma S, Ichikawa T, Miyaaki H, Haraguchi M, Tamada Y, Shibata H, Taura N, Soyama A, Hidaka M, Takatsuki M, Eguchi S, Nakao K. Efficacy and Tolerability of Pegylated Interferon and Ribavirin in Combination with Simeprevir to Treat Hepatitis C Virus Infections After Living Donor Liver Transplantation. J Interferon Cytokine Res 2016; 36:358-66. [DOI: 10.1089/jir.2015.0147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Satoshi Miuma
- Department of Gastroenterology, Hepatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Tatsuki Ichikawa
- Department of Gastroenterology, Hepatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
- Department of Gastroenterology, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan
| | - Hisamitsu Miyaaki
- Department of Gastroenterology, Hepatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Masafumi Haraguchi
- Department of Gastroenterology, Hepatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yoko Tamada
- Department of Gastroenterology, Hepatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Hidetaka Shibata
- Department of Gastroenterology, Hepatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Naota Taura
- Department of Gastroenterology, Hepatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Akihiko Soyama
- Department of Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Masaaki Hidaka
- Department of Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Mitsuhisa Takatsuki
- Department of Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Susumu Eguchi
- Department of Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Kazuhiko Nakao
- Department of Gastroenterology, Hepatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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Bunchorntavakul C, Reddy KR. Treat chronic hepatitis C virus infection in decompensated cirrhosis - pre- or post-liver transplantation? the ironic conundrum in the era of effective and well-tolerated therapy. J Viral Hepat 2016; 23:408-18. [PMID: 27018088 DOI: 10.1111/jvh.12534] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 03/01/2016] [Indexed: 12/12/2022]
Abstract
The management of hepatitis C virus (HCV) infection in patients with decompensated cirrhosis has evolved dramatically over the past few years mainly due to the availability of all-oral antiviral regimens. The currently approved all-oral direct-acting antivirals (DAA) containing sofosbuvir, ledipasvir, daclatasvir and ribavirin, in various combinations, have shown to be safe and effective in patients with decompensated cirrhosis with sustained virological response (SVR) rates nearly comparable to those with well-compensated liver disease. Unique issues yet remain such as the challenges with renal insufficiency, tolerability of ribavirin and risk of further hepatic decompensation with a protease inhibitor-based regimen. While most patients who achieve SVR have demonstrated improvement in hepatic synthetic function over the short course of follow, the long-term beneficial effects are unknown. Further, the baseline predictors of improvement in hepatic function have not been well delineated and thus have left us in a quandary as to what we might expect with successful therapy and thus we are at a loss to well educate our patients. The major concern, in potential liver transplant candidates, is of unintended 'harm' by achieving SVR but without improvement in hepatic function to an extent where the patients might function well. As HCV therapies are as effective in liver transplant recipients, there is a growing sentiment in some of the transplant quarters that those with decompensated liver disease and awaiting liver transplant be treated for HCV after liver transplant. This strategy would thus eliminate any concern of leaving a patient in 'no person's' land by treating HCV successfully pretransplant but not to the point of functional normalcy, while also would maintain the risk of HCC. Yet a contrarian view would be that not all patients have access to liver transplantation (LT), cannot bear the cost, have comorbidities or contraindications to LT. While the debate continues, it is essential that we develop robust predictors of improvement in liver function so that we can carefully select our patients for therapy in the context of liver transplantation.
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Affiliation(s)
- C Bunchorntavakul
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - K Rajender Reddy
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA
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Two-Year Follow-Up Analysis of Telaprevir-Based Antiviral Triple Therapy for HCV Recurrence in Genotype 1 Infected Liver Graft Recipients as a First Step towards Modern HCV Therapy. HEPATITIS RESEARCH AND TREATMENT 2016; 2016:8325467. [PMID: 27195149 PMCID: PMC4852367 DOI: 10.1155/2016/8325467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/08/2016] [Indexed: 12/15/2022]
Abstract
Objective. The introduction of protease inhibitors telaprevir and boceprevir in 2011 had extended the antiviral treatment options especially in genotype 1 infected hepatitis C relapsers and nonresponders to interferon/ribavirin therapy. The aim of this study was to analyze the long-term treatment efficiency of telaprevir-based triple therapy for patients with hepatitis C reinfection after orthotopic liver transplantation. Patients and Methods. We included 12 patients with histologically confirmed graft fibrosis due to hepatitis C reinfection. The treatment duration was scheduled as 12 weeks of telaprevir-based antiviral triple therapy followed by 36 weeks of dual therapy with pegylated interferon/ribavirin. The patients were followed up for two years after the end of triple therapy. Results. Of the 12 patients, 6 (50%) completed the full 48 weeks of antiviral treatment. An end of treatment response and a sustained virological response 52 weeks after the end of the antiviral treatment course were achieved in 8/12 (67%) and 7/12 (58%) patients, respectively. Conclusion. Telaprevir-based triple therapy was shown to be a long-term effective but complex treatment option for individual patients with hepatitis C graft. With the recent improvements in hepatitis C therapy options telaprevir may not be recommended as a standard therapy for this indication anymore.
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Llovet LP, Rodríguez-Tajes S, Londoño MC. Tratamiento de la hepatitis C en el pre- y postrasplante hepático. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 39:344-51. [DOI: 10.1016/j.gastrohep.2015.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/31/2015] [Accepted: 09/04/2015] [Indexed: 01/28/2023]
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Abstract
Recurrence of hepatitis C after liver transplantation is a major problem; it is characterized by high hepatitis C virus (HCV)-RNA, rapid progression, and cholestatic hepatitis. Treatment for HCV infection with peginterferon and ribavirin has been administered to prevent progression of hepatitis C after liver transplantation. However, it has low efficacy and causes many adverse events, including immune-mediated graft dysfunction. Interferon-containing regimens with direct-acting antivirals (DAAs) improve treatment efficacy but DAAs cause serious adverse events and drug-drug interactions. Recent studies have demonstrated the efficacy and safety of interferon-free therapy with DAAs before and after liver transplantation, which has ushered in a new era in the strategy for treating HCV in transplant recipients. Interferon-free therapies are safe and effective in patients before and after liver transplantation as well as in those with severe cholestatic hepatitis C. Several obstacles must be overcome before the widespread adoption of interferon-free therapy, including drug-drug interactions, DAA-resistant HCV, treatment for decompensated cirrhosis, and treatment for renal failure. These problems are expected to be solved in the near future, and the poor prognosis of HCV-positive recipients will improve.
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Herzer K, Papadopoulos-Köhn A, Walker A, Achterfeld A, Paul A, Canbay A, Timm J, Gerken G. Daclatasvir, Simeprevir and Ribavirin as a Promising Interferon-Free Triple Regimen for HCV Recurrence after Liver Transplant. Digestion 2016; 91:326-33. [PMID: 25999053 DOI: 10.1159/000382075] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 03/31/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recurrent hepatitis C infection after liver transplantation (LT) is associated with lower rates of graft and patient survival. METHODS Here we describe the first use of daclatasvir, simeprevir, and ribavirin (RBV) as an all-oral triple regimen administered to 6 liver transplant recipients with recurrent hepatitis C, one with GT 1a and 5 with GT 1b. All patients were treated for 24 weeks. Trough levels of immunosuppression, laboratory measures, and potential adverse effects were closely monitored. RESULTS For all patients, viral load became undetectable between treatment weeks 4 and 12. One patient experienced a viral breakthrough at the 10th week of treatment; this was associated with the selection of resistance-associated variants (D168Y in NS3 and ΔP32 in NS5A). For the other 5 patients, end-of-treatment response and for 4 patients SVR24 was achieved. Viremia recurred in one patient 4 weeks after the end of treatment, which was again associated with the selection of resistance-associated variants (D168V in NS3 and ΔP32 in NS5A). Clinical measures of liver function improved substantially for all patients. Adverse events were few and limited to moderate anemia caused by RBV. Importantly, adjustments to the immunosuppressant dosage were not required. CONCLUSIONS The described regimen appears to be safe and effective for liver transplant patients and will be a promising treatment regimen for post-LT patients.
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Affiliation(s)
- Kerstin Herzer
- Departments of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
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Patel N, Bichoupan K, Ku L, Yalamanchili R, Harty A, Gardenier D, Ng M, Motamed D, Khaitova V, Bach N, Chang C, Grewal P, Bansal M, Agarwal R, Liu L, Im G, Leong J, Kim-Schluger L, Odin J, Ahmad J, Friedman S, Dieterich D, Schiano T, Perumalswami P, Branch A. Hepatic decompensation/serious adverse events in post-liver transplantation recipients on sofosbuvir for recurrent hepatitis C virus. World J Gastroenterol 2016; 22:2844-2854. [PMID: 26973423 PMCID: PMC4778007 DOI: 10.3748/wjg.v22.i9.2844] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 10/27/2015] [Accepted: 11/19/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the safety profile of new hepatitis C virus (HCV) treatments in liver transplant (LT) recipients with recurrent HCV infection.
METHODS: Forty-two patients were identified with recurrent HCV infection that underwent LT at least 12 mo prior to initiating treatment with a Sofosbuvir-based regimen during December 2013-June 2014. Cases were patients who experienced hepatic decompensation and/or serious adverse events (SAE) during or within one month of completing treatment. Controls had no evidence of hepatic decompensation and/or SAE. HIV-infected patients were excluded. Cumulative incidence of decompensation/SAE was calculated using the Kaplan Meier method. Exact logistic regression analysis was used to identify factors associated with the composite outcome.
RESULTS: Median age of the 42 patients was 60 years [Interquartile Range (IQR): 56-65 years], 33% (14/42) were female, 21% (9/42) were Hispanic, and 9% (4/42) were Black. The median time from transplant to treatment initiation was 5.4 years (IQR: 2.1-8.8 years). Thirteen patients experienced one or more episodes of hepatic decompensation and/or SAE. Anemia requiring transfusion, the most common event, occurred in 62% (8/13) patients, while 54% (7/13) decompensated. The cumulative incidence of hepatic decompensation/SAE was 31% (95%CI: 16%-41%). Risk factors for decompensation/SAE included lower pre-treatment hemoglobin (OR = 0.61 per g/dL, 95%CI: 0.40-0.88, P < 0.01), estimated glomerular filtration rate (OR = 0.95 per mL/min per 1.73 m2, 95%CI: 0.90-0.99, P = 0.01), and higher baseline serum total bilirubin (OR = 2.43 per mg/dL, 95%CI: 1.17-8.65, P < 0.01). The sustained virological response rate for the cohort of 42 patients was 45%, while it was 31% for cases.
CONCLUSION: Sofosbuvir/ribavirin will continue to be used in the post-transplant population, including those with HCV genotypes 2 and 3. Management of anemia remains an important clinical challenge.
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