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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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Coilly A, Sebagh M, Fougerou-Leurent C, Pageaux GP, Leroy V, Radenne S, Silvain C, Lebray P, Houssel-Debry P, Cagnot C, Rossignol E, Danjou H, Veislinger A, Samuel D, Duclos-Vallée JC, Dumortier J. HCV eradication does not protect from fibrosis progression in patients with fibrosing cholestatic hepatitis after liver transplantation. Clin Res Hepatol Gastroenterol 2022; 46:102024. [PMID: 36122871 DOI: 10.1016/j.clinre.2022.102024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 09/05/2022] [Accepted: 09/11/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Hepatitis C virus (HCV) may recur after liver transplantation (LT) in the severe form of fibrosing cholestatic hepatitis (FCH). The prognosis dramatically improved by the use of direct acting antivirals (DAAs). The aim of the present study was to describe the change in histological features of FCH after virological eradication. METHODS From the ANRS CUPILT cohort we included 17 patients who presented FCH and at least two graft biopsies, one before DAA-treatment and one after. A single expert pathologist, blinded for clinical outcome, retrospectively confirmed the diagnosis of FCH and progression of fibrosis. RESULTS Diagnosis of FCH was made after a median [IQR] 6.0 [3.1-11.8] months after LT, and the median interval between diagnosis and onset of treatment was 1.2 [0.7-6.1] months. The rate of viral eradication was 94.1%. The median delay between the pre-treatment and the treatment biopsies was 12.5 [11.1-20.0] months. Between the end of treatment and the second biopsy, the delay was 5.3 [0.6-7.4] months. Fibrosis stage worsened in 10 patients (58.8%); 6 patients had cirrhosis (35.3%). Chronic rejection appeared in 4 (23.5%) patients. CONCLUSION Our results suggest that, despite viral eradication in patients presenting FCH after LT, fibrosis progression was observed in half of patients. This should encourage monitoring fibrosis progression despite HCV cure.
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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.
| | - Mylène Sebagh
- AP-HP Hôpital Bicêtre, Service d'Anatomie Pathologique, Kremlin-Bicêtre, France
| | - Claire Fougerou-Leurent
- Rennes University Hospital, Unit of Clinical Pharmacology; INSERM Clinical Investigation Centre 1414, Rennes, France
| | - Georges-Philippe Pageaux
- CHU Saint-Eloi, Département D'hépato-Gastroentérologie et de Transplantation Hépatique, Université Montpellier 1, Montpellier, France
| | - Vincent Leroy
- CHU de Grenoble, Pôle Digidune, Clinique Universitaire d'Hépato-Gastroentérologie; Unité INSERM /Université Grenoble Alpes U823, IAPC Institut Albert Bonniot, Grenoble, France
| | - Sylvie Radenne
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service d'Hépato-gastroentérologie, Lyon, France
| | - Christine Silvain
- Département d'Hépato-gastroentérologie, CHU de Poitiers, Pôle Biologie Santé, Poitiers EA 4331, France
| | - Pascal Lebray
- AP-HP, Departement d'hépatologie et de Gastroenterologie, Groupe Hospitalier Pitié-Salpétrière, Université Pierre et Marie Curie Paris 6, Paris, France
| | | | - Carole Cagnot
- Unit for Basic and Clinical Research on Viral Hepatitis, ANRS (France Recherche Nord&sud Sida-hiv Hépatites), Paris, France
| | - Emilie Rossignol
- Rennes University Hospital, Unit of Clinical Pharmacology; INSERM Clinical Investigation Centre 1414, Rennes, France
| | - Hélène Danjou
- Rennes University Hospital, Unit of Clinical Pharmacology; INSERM Clinical Investigation Centre 1414, Rennes, France
| | - Aurélie Veislinger
- Rennes University Hospital, Unit of Clinical Pharmacology; INSERM Clinical Investigation Centre 1414, Rennes, France
| | - Didier Samuel
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire; Université Paris-Saclay, UMR-S 1193; Inserm Unité 1193; FHU Hepatinov, Villejuif 94800, France
| | - Jean-Charles Duclos-Vallée
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire; Université Paris-Saclay, UMR-S 1193; Inserm Unité 1193; FHU Hepatinov, Villejuif 94800, France
| | - Jérôme Dumortier
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-gastroentérologie, Université Claude Bernard Lyon 1, Pavillons D et L, 69437, Lyon Cedex 03, France.
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Pinto L, Balbi E, Halpern M, Carius L, Roma J, Cardoso SW, Grinsztejn B, Veloso VG, Pacheco L, Perazzo H. Effectiveness of Direct-acting Agents After Liver Transplantation and Regression of Biomarkers Post-HCV Treatment: A Real-life Study in Rio de Janeiro. Arch Med Res 2022; 53:585-593. [PMID: 36114037 DOI: 10.1016/j.arcmed.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 09/01/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Data concerning hepatitis C virus (HCV) treatment using direct-acting agents (DAAs) post liver transplantation (LT) remains scarce in low- and average-income countries. AIM OF THE STUDY To evaluate the safety and efficacy of post-LT HCV treatment using DAAs in Rio de Janeiro (Brazil), and to assess the course of hepatic biomarkers after sustained virological response (SVR). METHODS Data from LT recipients with recurrent HCV treated using DAAs was retrospectively analyzed. HCV was defined by detectable HCV-RNA with elevated aminotransferases and/or histological signs of infection on liver biopsy post LT. SVR was defined as undetectable HCV-RNA 12 weeks after the end of treatment. Aspartate-to-Platelet Ratio Index (APRI) and Fibrosis-4 score (FIB-4) were calculated before treatment and after SVR. RESULTS 116 patients (63% male, median age 62 years, 75% genotype 1 and 62% with hepatocellular carcinoma [HCC] prior to LT) were included. Cirrhosis was identified in the allograft of 21 subjects (18%). The overall SVR was 96.6% without differences in SVR proportion according to clinical/demographic characteristics, genotype or presence of cirrhosis. SVR rates were similar in individuals with and without HCC pre-LT (95.8% [95% CI: 87.6-98.7] vs. 97.7% [95% CI: 85.0-99.7%], p = 0.588). No serious adverse events were observed and the use of ribavirin was associated with at least one adverse event (OR = 8.71 [95% CI: 3.17-23.99]). SVR was associated with regression of APRI (OR = 26.00 [95% CI 4.27-1065.94]) and FIB-4 (OR = 15.00 [95% CI: 2.30-631.47]). CONCLUSION Post-LT HCV treatment with DAAs was safe and effective and associated with a significant decrease in hepatic biomarker levels after SVR.
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Affiliation(s)
- Laura Pinto
- Laboratory of clinical research in STD/AIDS, Evandro Chagas National Institute of Infectious Diseases/Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; Liver Transplantation Group, Quinta D'Or Hospital, Rio de Janeiro, Brazil
| | - Elizabeth Balbi
- Liver Transplantation Group, Quinta D'Or Hospital, Rio de Janeiro, Brazil
| | - Marcia Halpern
- Liver Transplantation Group, Quinta D'Or Hospital, Rio de Janeiro, Brazil
| | - Luciana Carius
- Liver Transplantation Group, Quinta D'Or Hospital, Rio de Janeiro, Brazil
| | - Joyce Roma
- Liver Transplantation Group, Quinta D'Or Hospital, Rio de Janeiro, Brazil
| | - Sandra W Cardoso
- Laboratory of clinical research in STD/AIDS, Evandro Chagas National Institute of Infectious Diseases/Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Laboratory of clinical research in STD/AIDS, Evandro Chagas National Institute of Infectious Diseases/Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Valdilea G Veloso
- Laboratory of clinical research in STD/AIDS, Evandro Chagas National Institute of Infectious Diseases/Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Lucio Pacheco
- Liver Transplantation Group, Quinta D'Or Hospital, Rio de Janeiro, Brazil
| | - Hugo Perazzo
- Laboratory of clinical research in STD/AIDS, Evandro Chagas National Institute of Infectious Diseases/Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
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Silva IPL, Batista AD, Lopes EP, Filgueira NA, Carvalho BTD, Santos JC, Medeiros TBD, Melo CRLD, Lima MSD, Lima K, Lacerda C, Lacerda HR. A real-life study on the impact of direct-acting antivirals in the treatment of chronic hepatitis C in liver transplant recipients at two university centers in Northeastern Brazil. Rev Inst Med Trop Sao Paulo 2021; 63:e6. [PMID: 33533809 PMCID: PMC7845936 DOI: 10.1590/s1678-9946202163006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 12/14/2020] [Indexed: 12/24/2022] Open
Abstract
The efficacy of direct-acting antivirals (DAAs) in the treatment of chronic hepatitis C (CHC) in liver transplant recipients is poorly understood, and several factors, including immunosuppression, drug interactions, elevated viraemia, and intolerance to ribavirin (RBV), can reduce cure rates. We conducted a real-life study on liver transplant recipients with CHC treated with a combination of sofosbuvir (SOF) and daclatasvir (DCV) or simeprevir (SIM), with or without RBV, followed-up for 12 to 24 weeks. The treatment effectiveness was assessed by determining the sustained virological response (SVR) rates at 12 or 24 weeks after the treatment cessation. Eighty-four patients were evaluated, with a mean age of 63.4 ± 7.4 years, HCV genotype 1 being the most prevalent (63.1%). Nineteen patients (22.7%) had mild fibrosis (METAVIR < F2) and 41 (48.8%) significant fibrosis (METAVIR ≥ F2). The average time between liver transplantation and the start of treatment was 4 years (2.1-6.6 years). The SOF + DCV regimen was used in 58 patients (69%). RBV in combination with DAAs was used in seven patients (8.3%). SVR was achieved in 82 patients (97.6%), and few relevant adverse events could be attributed to DAA therapy, including a patient who stopped treatment due to a headache. There was a significant reduction in ALT, AST, GGT and FA levels, or the APRI index after 4 weeks of treatment, which remained until 12/24 weeks post-treatment. DAA treatment of CHC in liver-transplanted patients achieved a high SVR rate and resulted in the normalization of serum levels of liver enzymes.
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Affiliation(s)
- Isabella Patrícia Lima Silva
- Universidade Federal de Pernambuco, Centro de Ciências Médicas, Pós-Graduação em Medicina Tropical, Recife, Pernambuco, Brazil
| | - Andrea Dória Batista
- Universidade Federal de Pernambuco, Hospital das Clínicas, Serviço de Gastroenterologia e Hepatologia, Recife, Pernambuco, Brazil
| | - Edmundo Pessoa Lopes
- Universidade Federal de Pernambuco, Centro de Ciências Médicas, Pós-Graduação em Medicina Tropical, Recife, Pernambuco, Brazil
| | - Norma Arteiro Filgueira
- Universidade Federal de Pernambuco, Centro de Ciências Médicas, Departamento de Medicina Clínica, Recife, Pernambuco, Brazil
| | | | - Joelma Carvalho Santos
- Universidade Federal de Pernambuco, Centro de Ciências Médicas, Pós-Graduação em Medicina Tropical, Recife, Pernambuco, Brazil
| | - Tibério Batista de Medeiros
- Instituto Professor Fernando Figueira de Medicina Integral, Unidade de Transplante Geral, Serviço de Hepatologia, Recife, Pernambuco, Brazil
| | | | - Martha Sá de Lima
- Faculdade Maurício de Nassau, Recife, Pernambuco, Brazil.,Hospital Oswaldo Cruz, Serviço de Cirurgia Geral, Recife, Pernambuco, Brazil
| | - Kledoaldo Lima
- Universidade Federal de Pernambuco, Hospital das Clínicas, Laboratório Clínico, Recife, Pernambuco, Brazil.,European Virus Bioinformatics Center, Jena, Germany
| | - Claudio Lacerda
- Universidade de Pernambuco, Unidade de Transplante do Fígado, Recife, Pernambuco, Brazil.,Universidade de Pernambuco, Departamento de Cirurgia, Recife, Pernambuco, Brazil
| | - Heloisa Ramos Lacerda
- Universidade Federal de Pernambuco, Centro de Ciências Médicas, Pós-Graduação em Medicina Tropical, Recife, Pernambuco, Brazil.,Universidade Federal de Pernambuco, Centro de Ciências Médicas, Departamento de Medicina Clínica, Recife, Pernambuco, Brazil
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Lobato CMDO, Codes L, Silva GF, Souza AFM, Coelho HSM, Pedroso MLA, Parise ER, Lima LMSTDB, Borba LA, Evangelista AS, Rezende REF, Cheinquer H, Kuniyoshi ASO, Aires RS, Quintela EHD, Mendes LSC, Nascimento FCV, Medeiros Filho JEMD, Ferraz MLCG, Abdala E, Bittencourt PL. Direct antiviral therapy for treatment of hepatitis C: A real-world study from Brazil. Ann Hepatol 2020; 18:849-854. [PMID: 31537509 DOI: 10.1016/j.aohep.2019.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/31/2019] [Accepted: 08/06/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Direct antiviral agents (DAAs) including sofosbuvir (SOF), daclatasvir (DCV), simeprevir (SIM) and ombitasvir, paritaprevir and dasabuvir were introduced 2015 in Brazil for treatment of hepatitis C virus (HCV) infection. The aims of this study were to assess effectiveness and safety of HCV treatment with DAA in real-life world in a highly admixed population from Brazil. MATERIALS AND METHODS All Brazilian reference centers for HCV treatment were invited to take part in a web-based registry, prospectively conducted by the Brazilian Society of Hepatology, to assess outcomes of HCV treatment in Brazil with DAAs. Data to be collected included demographics, disease severity and comorbidities, genotype (GT), viral load, DAA regimens, treatment side effects and sustained virological response (SVR). RESULTS 3939 patients (60% males, mean age 58±10 years) throughout the country were evaluated. Most had advanced fibrosis or cirrhosis, GT1 and were treated with SOF/DCV or SOF/SIM. Overall SVR rates were higher than 95%. Subjects with decompensated cirrhosis, GT2 and GT3 have lower SVR rates of 85%, 90% and 91%, respectively. Cirrhosis and decompensated cirrhosis in GT1 and male sex and decompensated cirrhosis in GT3 were significantly associated with no SVR. Adverse events (AD) and serious AD occurred in 18% and 5% of those subjects, respectively, but less than 1% of patients required treatment discontinuation. CONCLUSION SOF-based DAA regimens are effective and safe in the heterogeneous highly admixed Brazilian population and could remain an option for HCV treatment at least in low-income countries.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Luiz Augusto Borba
- Ambulatório de Hepatites Virais da Prefeitura Municipal de Criciúma, Criciúma, SC, Brazil
| | | | | | - Hugo Cheinquer
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | | | | | | | | | | | - Edson Abdala
- Universidade de São Paulo, São Paulo, SP, Brazil
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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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Trilianos P, Tsangaris A, Tawadros A, Deshpande V, Pyrsopoulos N. The Reliability of Fibro-test in Staging Orthotopic Liver Transplant Recipients with Recurrent Hepatitis C. J Clin Transl Hepatol 2020; 8:9-12. [PMID: 32274340 PMCID: PMC7132024 DOI: 10.14218/jcth.2019.00038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/24/2019] [Accepted: 12/24/2019] [Indexed: 12/04/2022] Open
Abstract
Background and Aims: Liver biopsy remains the gold standard for staging of chronic liver disease following orthotopic liver transplantation. Noninvasive assessment of fibrosis with Fibro-test (FT) is well-studied in immunocompetent populations with chronic hepatitis C virus infection. The aim of this study is to investigate the diagnostic value of FT in the assessment of hepatic fibrosis in the allografts of liver transplant recipients with evidence of recurrent hepatitis C. Methods: We retrospectively compared liver biopsies and FT performed within a median of 1 month of each other in orthotopic liver transplantation recipients with recurrent hepatitis C. Results: The study population comprised 22 patients, most of them male (19/22), and with median age of 62 years. For all patients, there was at least a one-stage difference in fibrosis as assessed by liver biopsy compared to FT, while for the majority (16/22) there was at least a two-stage difference. The absence of correlation between the two modalities was statistically demonstrated (Mann-Whitney U test, p = 0.01). In detecting significant fibrosis (a METAVIR stage of F2 and above), an FT cut-off of 0.5 showed moderate sensitivity (77%) and negative predictive value (80%), but suboptimal specificity (61%) and positive predictive value (58%). Conclusions: In post-transplant patients with recurrent hepatitis C, FT appears to be inaccurately assessing the degree of allograft fibrosis, therefore limiting its reliability as a staging tool.
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Affiliation(s)
| | | | | | | | - Nikolaos Pyrsopoulos
- Correspondence to: Nikolaos Pyrsopoulos, Division of Gastroenterology & Hepatology, University Hospital, Rutgers - New Jersey Medical School, Medical Science Building, Room H-536, 185 S. Orange Ave, Newark, NJ 07103, USA. Tel: +1-973-972-5252, Fax: +1-973-972-3144, E-mail:
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8
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Ridruejo E, Cheinquer H, Marciano S, Mendizabal M, Piñero F, Wolff FH, de Araujo A, Coelho Borges S, Kliemann D, Fleck A, de Maman Í, Nader LA, Garrastazul P, Bermúdez C, Haddad L, Gadano A, Silva M. B.A.R.C.O.S. (Brazilian Argentine Hepatitis C Collaborative Observational Study): Effectiveness and clinical outcomes of HCV treatment with daclatasvir and sofosbuvir with or without ribavirin. J Viral Hepat 2019; 26:1200-1209. [PMID: 31141239 DOI: 10.1111/jvh.13148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/17/2019] [Accepted: 05/14/2019] [Indexed: 12/22/2022]
Abstract
Real-world data evaluating the effectiveness of direct-acting antivirals (DAAs) in hepatitis C virus (HCV) treatment have been reported from different regions. Our aim was to evaluate the effectiveness and clinical outcomes of daclatasvir (DCV) and sofosbuvir (SOF) ± ribavirin (RBV) in a prospective multicentre cohort study including patients from Argentina and Brazil who received DCV/SOF ± RBV for 12 or 24 weeks from 2015 to 2018. Multivariable logistic regression models were carried out to identify factors associated with failure to achieve sustained virologic response (SVR) as a primary end point, and to death, decompensation, hepatocellular carcinoma (HCC) or liver transplantation (LT) as a composite secondary end point. From a total of 1517 patients treated with DCV/SOF, 906 completed 12 weeks post-treatment evaluation and were included in the analysis. Overall SVR12 rate was 96.1% (95% CI: 94.6%-97.2%), and 95% (95% CI: 92.8%-96.6%) in patients with cirrhosis. LT recipients and presence of cirrhosis were independently associated with failure to achieve SVR. During post-SVR12 follow-up, cumulative incidence of the secondary end point was 2.4% (95% CI: 1.5%-3.6%); two patients died from nonliver-related causes and two from HCC, five underwent LT, 12 developed HCC and 17 patients developed hepatic decompensation. Independent variables associated with these composite secondary end points were prior to HCV treatment and presence of cirrhosis. In conclusion, although the high pangenotypic effectiveness of DCV/SOF ± RBV was confirmed in our real-life cohort, patients with compensated and decompensated cirrhosis showed higher risk of non-SVR and complication appearance during treatment or after achieving SVR.
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Affiliation(s)
- Ezequiel Ridruejo
- Hepatology Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas, Norberto Quirno 'CEMIC', Buenos Aires, Argentina.,Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Presidente Derqui, Buenos Aires, Argentina.,Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina
| | - Hugo Cheinquer
- Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina.,Gastroenterology and Hepatology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Sebastián Marciano
- Liver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.,Research Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Manuel Mendizabal
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Presidente Derqui, Buenos Aires, Argentina.,Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina
| | - Federico Piñero
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Presidente Derqui, Buenos Aires, Argentina.,Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina
| | - Fernando H Wolff
- Gastroenterology and Hepatology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Alexandre de Araujo
- Gastroenterology and Hepatology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Silvia Coelho Borges
- Gastroenterology and Hepatology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Dimas Kliemann
- Gastroenterology and Hepatology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Alfeu Fleck
- Gastroenterology and Hepatology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Ítalo de Maman
- Gastroenterology and Hepatology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Lysandro A Nader
- Gastroenterology and Hepatology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Patricia Garrastazul
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Presidente Derqui, Buenos Aires, Argentina
| | - Carla Bermúdez
- Liver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Leila Haddad
- Liver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Adrián Gadano
- Liver Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.,Research Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marcelo Silva
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Presidente Derqui, Buenos Aires, Argentina.,Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina
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9
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Smolders EJ, Jansen AME, Ter Horst PGJ, Rockstroh J, Back DJ, Burger DM. Viral Hepatitis C Therapy: Pharmacokinetic and Pharmacodynamic Considerations: A 2019 Update. Clin Pharmacokinet 2019; 58:1237-1263. [PMID: 31114957 PMCID: PMC6768915 DOI: 10.1007/s40262-019-00774-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
It has been estimated by the World Health Organization (WHO) that over 71 million people were infected with the hepatitis C virus (HCV) in 2015. Since then, a number of highly effective direct-acting antiviral (DAA) regimens have been licensed for the treatment of chronic HCV infection: sofosbuvir/daclatasvir, sofosbuvir/ledipasvir, elbasvir/grazoprevir, sofosbuvir/velpatasvir, glecaprevir/pibrentasvir, and sofosbuvir/velpatasvir/voxilaprevir. With these treatment regimens, almost all chronic HCV-infected patients, even including prior DAA failures, can be treated effectively and safely. It is therefore likely that further development of DAAs will be limited. In this descriptive review we provide an overview of the clinical pharmacokinetic characteristics of currently available DAAs by describing their absorption, distribution, metabolism, and excretion. Potential drug-drug interactions with the DAAs are briefly discussed. Furthermore, we summarize what is known about the pharmacodynamics of the DAAs in terms of efficacy and safety. We briefly discuss the relationship between the pharmacokinetics of the DAAs and efficacy or toxicity in special populations, such as hard to cure patients and patients with liver cirrhosis, liver transplantation, renal impairment, hepatitis B virus or HIV co-infection, bleeding disorders, and children. The aim of this overview is to educate/update prescribers and pharmacists so that they are able to safely and effectively treat HCV-infected patients even in the presence of underlying co-infections or co-morbidities.
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Affiliation(s)
- Elise J Smolders
- Department of Pharmacy, Isala Hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
- Department of Pharmacy, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - Anouk M E Jansen
- Department of Pharmacy, Isala Hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Peter G J Ter Horst
- Department of Pharmacy, Isala Hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Jürgen Rockstroh
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - David J Back
- Department of Clinical and Molecular Pharmacology, University of Liverpool, Liverpool, UK
| | - David M Burger
- Department of Pharmacy, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
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10
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International Liver Transplantation Society Asian Consensus on the Management of Hepatitis C Virus Infection in Resource Limited Setting-From Noncirrhotic to Decompensated Disease and After Liver Transplantation. Transplantation 2019; 103:733-746. [PMID: 30335692 DOI: 10.1097/tp.0000000000002453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The population of Asia exceeds 4.4 billion people. Chronic hepatitis C virus (HCV) infection in Asia is characterized by specific distribution of genotypes, lack of access to specific therapeutic agents, relatively high cost of treatment, and lack of experienced healthcare providers. Clear consensus on the diagnosis, management, and monitoring of HCV infection specific to the Asian region is a major unmet need. The consensus guidelines documents that have been published to date by major medical societies presume access to an array of direct acting antiviral agents and diagnostic tests that are not broadly applicable to resource limited settings, including Asia. METHODS To address the lack of an Asia-specific set of HCV treatment guidelines, we assembled a panel of 15 HCV experts in the field of hepatology from India, Indonesia, Myanmar, Vietnam, Pakistan, Philippines, and Mongolia convened in April 2017 to review the updated literature and provide recommendations on the diagnosis and management of chronic HCV infection that reflects local conditions. RESULTS An evidence-based comprehensive compilation of the literature supported by the graded recommendations from the expert panel for the optimization of the diagnosis, pretreatment, on treatment, and posttreatment assessments, and management of chronic HCV infection has been presented in this article. CONCLUSIONS With the evolving treatment landscape and addition of several new direct-acting antiviral agents and combination regimens into the therapeutic armamentarium, the current article may serve as a guide to the clinicians in optimizing the diagnosis and treatment selection for the management of chronic HCV infection in resource-limited settings.
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11
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Barrail-Tran A, Goldwirt L, Gelé T, Laforest C, Lavenu A, Danjou H, Radenne S, Leroy V, Houssel-Debry P, Duvoux C, Kamar N, De Ledinghen V, Canva V, Conti F, Durand F, D'Alteroche L, Botta-Fridlund D, Moreno C, Cagnot C, Samuel D, Fougerou-Leurent C, Pageaux GP, Duclos-Vallée JC, Taburet AM, Coilly A. Comparison of the effect of direct-acting antiviral with and without ribavirin on cyclosporine and tacrolimus clearance values: results from the ANRS CO23 CUPILT cohort. Eur J Clin Pharmacol 2019; 75:1555-1563. [PMID: 31384986 DOI: 10.1007/s00228-019-02725-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/17/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Direct-acting antiviral agents have demonstrated their efficacy in treating HCV recurrence after liver transplantation and particularly the sofosbuvir/daclatasvir combination. Pharmacokinetic data on both calcineurin inhibitors and direct-acting antiviral exposure in liver transplant recipients remain sparse. METHODS Patients were enrolled from the ANRS CO23 CUPILT cohort. All patients treated with sofosbuvir/daclatasvir with or without ribavirin were included in this study when blood samples were available to estimate the clearance of immunosuppressive therapy before direct-acting antiviral initiation and during follow-up. Apparent tacrolimus and cyclosporine clearances were estimated from trough concentrations measured using validated quality control assays. RESULTS Sixty-seven mainly male patients (79%) were included, with a mean age of 57 years and mean MELD score of 8.2; 50 were on tacrolimus, 17 on cyclosporine. Ribavirin was combined with sofosbuvir/daclatasvir in 52% of patients. Cyclosporine clearance remained unchanged as well as tacrolimus clearance under the ribavirin-free regimen. Tacrolimus clearance increased 4 weeks after direct-acting antivirals and ribavirin initiation versus baseline (geometric mean ratio 1.81; 90% CI 1.30-2.52). Patients under ribavirin had a significantly higher fibrosis stage (> 2) (p = 0.02) and lower haemoglobin during direct-acting antiviral treatment (p = 0.02) which impacted tacrolimus measurements. Direct-acting antiviral exposure was within the expected range. CONCLUSION Our study demonstrated that liver transplant patients with a recurrence of hepatitis C who are initiating ribavirin combined with a sofosbuvir-daclatasvir direct-acting antiviral regimen may be at risk of lower tacrolimus concentrations because of probable ribavirin-induced anaemia and higher fibrosis score, although there are no effects on cyclosporine levels. TRIAL REGISTRATION NCT01944527.
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Affiliation(s)
- Aurélie Barrail-Tran
- AP-HP, Hôpital Bicêtre, Department of Clinical Pharmacy, Hôpitaux Universitaires Paris Sud, Kremlinl-Bicêtre, France.
- Department of Clinical Pharmacy, Université Paris Sud, Châtenay Malabry, France.
- INSERM UMR1184, CEA, Université Paris Sud, Immunologie des Maladies Virales et Autoimmunes (IMVA), Kremlin-Bicêtre, France.
| | - Lauriane Goldwirt
- Department of Pharmacology, Assistance Publique Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Thibaut Gelé
- AP-HP, Hôpital Bicêtre, Department of Clinical Pharmacy, Hôpitaux Universitaires Paris Sud, Kremlinl-Bicêtre, France
| | - Claire Laforest
- CHU Rennes, Service de Pharmacologie, Rennes, France
- INSERM, CIC 1414, Rennes, France
| | - Audrey Lavenu
- INSERM, CIC 1414, Rennes, France
- University of Rennes 1, Laboratory of Experimental and Clinical Pharmacology, Rennes, France
| | - Hélène Danjou
- CHU Rennes, Service de Pharmacologie, Rennes, France
- INSERM, CIC 1414, Rennes, France
| | - Sylvie Radenne
- Service d'Hépato-Gastroentérologie, HCL Hôpital de la Croix-Rousse, Lyon, France
| | - Vincent Leroy
- Service d'Hépato-Gastroentérologie, CHU Michallon, Grenoble, France
| | | | - Christophe Duvoux
- Service d'Hépato-Gastroentérologie, AP-HP Hôpital Henri-Mondor, Créteil, France
| | - Nassim Kamar
- Service de Néphrologie, HTA, Dialyse, Transplantation, CHU Rangueil, Toulouse, France
| | | | - Valérie Canva
- Service des Maladies de l'Appareil Digestif, CHRU Huriez, Lille, France
| | - Filomena Conti
- Service de Chirurgie Hépatobiliaire et Transplantation Hépatique, AP-HP Hôpital Pitié-Salpêtrière, Paris, France
| | - François Durand
- Service d'Hépatologie, AP-HP Hôpital Beaujon, Clichy, France
| | | | | | - Christophe Moreno
- CUB, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Carole Cagnot
- Unit for Basic and Clinical Research on Viral Hepatitis ANRS (France REcheche Nord&sud Sida-hiv Hépatites), Paris, France
| | - Didier Samuel
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France
- Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France
- Inserm, Unité 1193, Université Paris-Saclay, Villejuif, France
- Hepatinov, Villejuif, France
| | | | - Georges-Philippe Pageaux
- Department of Hepatogastroenterology, CHU Saint Eloi, Université de Montpellier, Montpellier, France
| | - Jean-Charles Duclos-Vallée
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France
- Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France
- Inserm, Unité 1193, Université Paris-Saclay, Villejuif, France
- Hepatinov, Villejuif, France
| | - Anne-Marie Taburet
- AP-HP, Hôpital Bicêtre, Department of Clinical Pharmacy, Hôpitaux Universitaires Paris Sud, Kremlinl-Bicêtre, France
- INSERM UMR1184, CEA, Université Paris Sud, Immunologie des Maladies Virales et Autoimmunes (IMVA), Kremlin-Bicêtre, France
- Hepatinov, Villejuif, France
| | - Audrey Coilly
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France
- Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France
- Inserm, Unité 1193, Université Paris-Saclay, Villejuif, France
- Hepatinov, Villejuif, France
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12
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Kapila N, Khalloufi KA, Flocco G, Menon KN, Lindenmeyer C, Reino D, Vanatta JM, Ebaid S, Tzakis A, Zervos XB. Transplantation of HCV Viremic Livers into HCV Viremic Recipients Followed by Direct-acting Antiviral Therapy. J Clin Transl Hepatol 2019; 7:122-126. [PMID: 31293911 PMCID: PMC6609846 DOI: 10.14218/jcth.2019.00014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/26/2019] [Accepted: 05/15/2019] [Indexed: 12/19/2022] Open
Abstract
Background and Aims: Hepatitis C virus (HCV)-infected organs are underutilized. We aimed to assess the safety and efficacy of direct-acting antiviral agents (DAAs) therapy in HCV viremic patients who are transplanted with a liver from a HCV viremic donor. Methods: We conducted a retrospective study, including patients seen from July 2015 to April 2017. HCV viremic patients transplanted with a liver from a HCV viremic donor and subsequently treated with DAAs were included. Outcomes assessed included undetectable viral load at 12 weeks after completing DAA therapy (sustained virologic response, SVR12), adverse events, and interactions with immunosuppression. Results: Twenty-four HCV viremic recipients received livers from HCV viremic donors. Median age was 63 years, and the majority (79.2%) were genotype 1a. Donors and recipients were viremic at the time of transplant. Median modified model for end-stage liver disease score was 19, and median time on the waitlist was 81 days. Median time from transplant to initiation of DAA therapy was 123 days. Several DAA regimens were used and 15 (62.5%) patients did not receive ribavirin. Treatment duration ranged from 12 to 24 weeks. Twenty-three (95.8%) patients achieved SVR12. Five (20.8%) patients developed adverse events; however, none required DAA discontinuation. Conclusions: DAA therapy was efficacious and well tolerated in HCV viremic recipients who underwent liver transplantation from a HCV viremic donor.
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Affiliation(s)
- Nikhil Kapila
- Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FL, USA
| | | | - Gianina Flocco
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - K.V. Narayanan Menon
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Diego Reino
- Department of Transplant, Cleveland Clinic Florida, Weston, FL, USA
| | - Jason M. Vanatta
- Department of Transplant, Cleveland Clinic Florida, Weston, FL, USA
| | - Samer Ebaid
- Department of Transplant, Cleveland Clinic Florida, Weston, FL, USA
| | - Andreas Tzakis
- Department of Transplant, Cleveland Clinic Florida, Weston, FL, USA
| | - Xaralambos Bobby Zervos
- Department of Transplant, Cleveland Clinic Florida, Weston, FL, USA
- *Correspondence to: Xaralambos Bobby Zervos, Department of Transplant, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA. Tel: +1-954-659-5133, Fax: +1-954-659-6731, E-mail:
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13
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Mucenic M, Brandão ABDM, Marroni CA, Fleck Junior ADM, Zanotelli ML, Leipnitz I, Meine MH, Kiss G, Martini J, Schlindwein ES, Costabeber AM, Sacco FKR, Rossato G, Cantisani GPC. Sofosbuvir, ribavirin and pegylated interferon for a daclatasvir-resistent genotype 3 hepatitis C virus: case report and review. Rev Inst Med Trop Sao Paulo 2019; 61:e12. [PMID: 30785566 PMCID: PMC6376924 DOI: 10.1590/s1678-9946201961012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/16/2019] [Indexed: 12/14/2022] Open
Abstract
Chronic Hepatitis C relapse after liver transplantation can lead to graft failure
within a short time period. The high efficacy and good safety profile of
direct-acting antivirals has led to consensual recommendations for using
interferon-free treatment after liver transplantation. However, pegylated
interferon may still be required for genotype 3 non-responders. We treated a
liver graft recipient with grade 1 fibrosis in the biopsy with daclatasvir and
sofosbuvir for 12 weeks. He did not respond and progressed to grade 3 fibrosis.
Lacking other options, we obtained a sustained virological response with
pegylated interferon, ribavirin and sofosbuvir for 12 weeks. The combination of
pegylated interferon, ribavirin and sofosbuvir is a viable option after the
failure of direct acting antivirals in economically disadvantaged countries.
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Affiliation(s)
- Marcos Mucenic
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Grupo de Transplante Hepático, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ajacio Bandeira de Melo Brandão
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Grupo de Transplante Hepático, Porto Alegre, Rio Grande do Sul, Brazil
| | - Claudio Augusto Marroni
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Grupo de Transplante Hepático, Porto Alegre, Rio Grande do Sul, Brazil
| | - Alfeu de Medeiros Fleck Junior
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Grupo de Transplante Hepático, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria Lucia Zanotelli
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Grupo de Transplante Hepático, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ian Leipnitz
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Grupo de Transplante Hepático, Porto Alegre, Rio Grande do Sul, Brazil
| | - Mário Henrique Meine
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Grupo de Transplante Hepático, Porto Alegre, Rio Grande do Sul, Brazil
| | - Guillermo Kiss
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Grupo de Transplante Hepático, Porto Alegre, Rio Grande do Sul, Brazil
| | - Juliano Martini
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Grupo de Transplante Hepático, Porto Alegre, Rio Grande do Sul, Brazil
| | - Eduardo Soares Schlindwein
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Grupo de Transplante Hepático, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ane Micheli Costabeber
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Grupo de Transplante Hepático, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Giovana Rossato
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Grupo de Transplante Hepático, Porto Alegre, Rio Grande do Sul, Brazil
| | - Guido Pio Cracco Cantisani
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Grupo de Transplante Hepático, Porto Alegre, Rio Grande do Sul, Brazil
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14
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Hu C, Yuan G, Liu J, Huang H, Ren Y, Li Y, Chen X, Li W, Wu T, Deng H, Peng Y, Zhang YY, Zhou Y. Sofosbuvir-Based Therapies for Patients with Hepatitis C Virus Infection: Real-World Experience in China. Can J Gastroenterol Hepatol 2018; 2018:3908767. [PMID: 30538973 PMCID: PMC6258099 DOI: 10.1155/2018/3908767] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/06/2018] [Accepted: 07/02/2018] [Indexed: 01/13/2023] Open
Abstract
Background and Aims There is scarcity of data in literature regarding the treatment response to sofosbuvir- (SOF-) based therapies in Chinese patients with chronic Hepatitis C Virus (HCV) infection. The aim of this study was to evaluate the efficacy and safety of SOF-based regimens for chronic hepatitis C (CHC) patients without cirrhosis in a real-world setting in mainland China. Methods A total of 226 patients receiving SOF plus daclatasvir (DCV), ledipasvir (LDV), or velpatasvir (VEL) were enrolled from December 2014 to June 2017. The primary observation point was the percentage of patients with a sustained virologic response (SVR) at posttreatment week 12 (SVR12), and all adverse events were monitored during treatment and follow-up period. Results The overall SVR12 rate was 96% (216/226), and individual SVR12 ranged from 93% to 100% in different treatment groups. No significant differences of efficacy were detected between genotypes 1b and 6a (98% for GT 1b versus 100% for GT 6a, P=0.322). Comparing the high success rates in GT 1b and 6a patients, SVR12 was relatively low in GT 3a and 3b patients. A significant difference in efficacy was observed between GT 3 and not GT 3 patients (77% versus 98%, respectively, P<0.001). No significant differences in efficacy were detected among different regimens (93% versus 97% versus 100%, respectively, P=0.153), gender (95% for male versus 96% for female, P=0.655), or baseline HCV RNA lever (96% versus 95%, respectively, P=0.614). Similar SVR rates were also obtained in naïve and previously treated patients (98% versus 93%, respectively, P=0.100). Conclusions NS5B polymerase inhibitor SOF plus one of the NS5A inhibitors, such as DCV, LDV, or VEL for 12 weeks was associated with high SVR12 rates and well tolerated in HCV-infected patients without cirrhosis. Moreover, patients with DAAs failure should be retreated with more effective regimens like SOF/VEL.
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Affiliation(s)
- Chengguang Hu
- Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guosheng Yuan
- Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Junwei Liu
- Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Huaping Huang
- Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanyu Ren
- Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yinping Li
- Department of Infectious Diseases, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Xuefu Chen
- Department of Infectious Diseases, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Wei Li
- Department of Infectious Diseases, Henan Provincial People's Hospital, Zhengzhou, Henan Province, China
| | - Tao Wu
- Department of Infectious Disease, Hainan General Hospital, Haikou City, Hainan Province, China
| | - Hong Deng
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yanzhong Peng
- Department of Infectious Diseases, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | | | - Yuanping Zhou
- Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, China
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15
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Houssel-Debry P, Coilly A, Fougerou-Leurent C, Jezequel C, Duvoux C, De Ledinghen V, Radenne S, Kamar N, Leroy V, Martino VD, D'Alteroche L, Canva V, Conti F, Dumortier J, Montialoux H, Lebray P, Botta-Fridlund D, Tran A, Moreno C, Silvain C, Besch C, Perre P, Francoz C, Abergel A, Habersetzer F, Debette-Gratien M, Cagnot C, Diallo A, Chevaliez S, Rossignol E, Veislinger A, Duclos-Vallee JC, Pageaux GP. 12 Weeks of a Ribavirin-Free Sofosbuvir and Nonstructural Protein 5A Inhibitor Regimen Is Enough to Treat Recurrence of Hepatitis C After Liver Transplantation. Hepatology 2018; 68:1277-1287. [PMID: 29633389 DOI: 10.1002/hep.29918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 04/02/2018] [Indexed: 12/12/2022]
Abstract
UNLABELLED Sofosbuvir (SOF) combined with nonstructural protein 5A (NS5A) inhibitors has demonstrated its efficacy in treating a recurrence of hepatitis C virus (HCV) after liver transplantation (LT). However, the duration of treatment and need for ribavirin (RBV) remain unclear in this population. Our aim was to determine whether LT recipients could be treated with an SOF + NS5A inhibitor-based regimen without RBV for 12 weeks post-LT. Between October 2013 and December 2015, 699 LT recipients experiencing an HCV recurrence were enrolled in the multicenter ANRS CO23 CUPILT cohort. We selected patients receiving SOF and NS5A inhibitor ± RBV and followed for at least 12 weeks after treatment discontinuation. The primary efficacy endpoint was a sustained virological response 12 weeks after the end of treatment (SVR12). Among these 699 patients, 512 fulfilled the inclusion criteria. Their main characteristics were: 70.1% genotype 1, 18.2% genotype 3, 21.1% cirrhosis, and 34.4% previously treated patients. We identified four groups of patients according to their treatment and duration: SOF + NS5A without RBV for 12 (156 patients) or 24 (239 patients) weeks; SOF + NS5A + RBV for 12 (47 patients) or 24 (70 patients) weeks. SVR12 values reached 94.9%, 97.9%, 95.7%, and 92.9%, respectively (P = 0.14). Only 20 patients experienced a treatment failure. Under multivariate analysis, factors such as fibrosis stage, previous treatment, HCV genotype, and baseline HCV viral load did not influence SVR12 rates in the four groups (P = 0.21). Hematological adverse events (AEs) were more common in the RBV group: anemia (P < 0.0001) and blood transfusion (P = 0.0001). CONCLUSION SOF + NS5A inhibitors without RBV for 12 weeks constituted reliable therapy for recurrent HCV post-LT with an excellent SVR12 whatever the fibrosis stage, HCV genotype, and previous HCV treatment. (Hepatology 2018; 00:000-000).
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Affiliation(s)
- Pauline Houssel-Debry
- Hepatology and Liver Transplant Unit, Pontchaillou University Hospital, Rennes, 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
- Pharmacology Unit, CHU Rennes, Rennes, France.,INSERM, CIC 1414 Clinical Investigation Centre, Rennes, France
| | - Caroline Jezequel
- Hepatology and Liver Transplant Unit, Pontchaillou University Hospital, Rennes, France
| | | | | | - Sylvie Radenne
- Hepatology Unit, HCL, Hôpital de la Croix-Rousse, Lyon, 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
| | - Vincent Di Martino
- Hepatology Unit, CHRU Jean Minjoz Franche Comté University, Besançon, France
| | | | - Valérie Canva
- CHRU Lille, Hepatology Unit, Claude Huriez Hospital, CHRU Lille, Lille, France
| | - Filomena Conti
- Hepatology and Liver Transplant Unit, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Jerome Dumortier
- Liver Transplant Unit, Digestive Diseases Federation, Edouard Herriot Hospital, Hospices Civils de Lyon Université Claude Bernard Lyon 1, Lyon, France
| | | | - Pascal Lebray
- Hepatology and Liver Transplant Unit, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | - Albert Tran
- Hepatogastroenterology Unit, Nice University Hospital, INSERM, U1065, Equipe 8, Nice Sophia Antipolis University, Faculty of Medicine, Nice, Cedex 2, Nice, France
| | - Christophe Moreno
- Hepatogastroenterology Unit, CUB Hôpital Erasme, Brussels University, Bruxelles, Belgique
| | | | - Camille Besch
- Liver Transplant and Digestive Surgery Unit, Strasbourg University, Strasbourg, France
| | - Philippe Perre
- Infectious Diseases Unit, CHD Vendée, La Roche sur Yon, Strasbourg, France
| | - Claire Francoz
- Hepatology Unit, Beaujon Hospita, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Armando Abergel
- Hepatogastroenterology Unit, CHU Estaing Clermont-Ferrand, Clermont-Ferrand, France
| | - François Habersetzer
- Universitary Hospitals of Strasbourg, Inserm U 1110, LabEx HepSYS, Strasbourg University, Strasbourg, France
| | | | - Carole Cagnot
- Unité de recherche Clinique et Fondamentale sur les Hépatites Virales, ANRS (France REcherche Nord&sud Sida-hiv Hépatites), Paris, France
| | - Alpha Diallo
- Unité de recherche Clinique et Fondamentale sur les Hépatites Virales, ANRS (France REcherche Nord&sud Sida-hiv Hépatites), Paris, France
| | - Stéphane Chevaliez
- Virology Unit, French National Reference Center for Viral Hepatitis B, C and delta French National Reference Center for Viral Hepatitis B, C and delta, Hôpital Henri Mondor, Université Paris 12, Paris, France
| | - Emilie Rossignol
- Pharmacology Unit, CHU Rennes, Rennes, France.,INSERM, CIC 1414 Clinical Investigation Centre, Rennes, France
| | - Aurélie Veislinger
- Pharmacology Unit, CHU Rennes, Rennes, France.,INSERM, CIC 1414 Clinical Investigation Centre, Rennes, France
| | - Jean-Charles Duclos-Vallee
- 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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Sofosbuvir-Based Regimens in HIV/HCV Coinfected Patients After Liver Transplantation: Results From the ANRS CO23 CUPILT Study. Transplantation 2018; 102:119-126. [PMID: 28846559 DOI: 10.1097/tp.0000000000001928] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND A recurrence of hepatitis C virus (HCV) after liver transplantation affects survival in human immunodeficiency virus (HIV)/HCV coinfected patients. This study assessed the efficacy and safety of sofosbuvir (SOF)-based regimens in HIV/HCV coinfected patients after liver transplantation. METHODS Twenty-nine HIV/HCV coinfected transplanted patients receiving tacrolimus-, cyclosporine-, or everolimus-based immunosuppressive therapy were enrolled in the Compassionate Use of Protease Inhibitors in Viral C Liver Transplantation cohort. Their antiviral treatment combined SOF, daclatasvir with or without ribavirin (n = 10/n = 6), or SOF, ledipasvir with or without ribavirin (n = 2/n = 11). RESULTS The median delay between liver transplantation and treatment initiation was 37.5 months (interquartile range [IQR], 14.4-99.2). The breakdown of HCV genotypes was G1, 22 patients (75.9%); G3, 3 patients (10.3%); and G4, 4 patients (13.8%). The treatment indications were HCV recurrence (≥ F1 n = 23) or fibrosing cholestatic hepatitis (n = 6). Before starting SOF, the HCV viral load and CD4 count were 6.7 log10 IU/mL (IQR, 5.9-7.2) and 342 cells/mm (IQR, 172-483), respectively. At week 4, the HCV viral load was less than 15 IU/mL in 12 (42.9%) patients. The overall sustained virological response 12 was 96.6%. No significant drug-drug interactions were observed. CONCLUSIONS SOF-based treatment regimens produced excellent results in HIV/HCV coinfected patients after liver transplantation, suggesting an important change in their prognosis.
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17
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Kim JM, Lee KW, Sinn DH, Choi GS, Yi NJ, Kwon CHD, Suh KS, Joh JW. Use of direct antiviral agents in liver transplant recipients with hepatitis C virus in Korea: 2-center experience. Ann Surg Treat Res 2018; 95:147-151. [PMID: 30182021 PMCID: PMC6121168 DOI: 10.4174/astr.2018.95.3.147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/14/2018] [Accepted: 01/30/2018] [Indexed: 12/19/2022] Open
Abstract
Purpose The proportion of liver recipients with HCV is gradually increasing in Korea. Limited data are available regarding the efficacy of direct antiviral agents (DAAs) in liver transplant recipients in Asia. We aimed to assess the efficacy and safety of DAAs in HCV-infected liver recipients in Korea. Methods Forty HCV-infected patients from 2 centers received DAAs in the pretransplant or posttransplant period between May 2015 and November 2016. Results DAA was administered in the pretransplant period in 6 patients and the posttransplant period in 34 patients. Dalastavir and asunaprevir (n = 2) and sofosbuvir/ledipasvir and ribvarin (n = 4) were used in the pretransplant period. HCV RNA was not detected before liver transplantation in all patients. Sustained virological response (SVR) at 12 and 24 weeks after liver transplantation was 100%. In the posttransplant period, 33 of 34 patients received sofosfovir-based therapy. SVR at 12 weeks in those patients was 94%. Recurrent virologic relapse developed in 2 patients because of HCC recurrence or treatment failure. Adverse events included anemia (n = 2) and abdominal discomfort (n = 1). Conclusion DAAs are an effective and well-tolerated treatment for HCV-infected recipients in Korea.
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Affiliation(s)
- Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Hyun Sinn
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Choon Hyuck David Kwon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Burra P, Giannini EG, Caraceni P, Ginanni Corradini S, Rendina M, Volpes R, Toniutto P. Specific issues concerning the management of patients on the waiting list and after liver transplantation. Liver Int 2018; 38:1338-1362. [PMID: 29637743 DOI: 10.1111/liv.13755] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/27/2018] [Indexed: 02/06/2023]
Abstract
The present document is a second contribution collecting the recommendations of an expert panel of transplant hepatologists appointed by the Italian Association for the Study of the Liver (AISF) concerning the management of certain aspects of liver transplantation, including: the issue of prompt referral; the management of difficult candidates; malnutrition; living related liver transplants; hepatocellular carcinoma; and the role of direct acting antiviral agents before and after transplantation. The statements on each topic were approved by participants at the AISF Transplant Hepatology Expert Meeting organized by the Permanent Liver Transplant Commission in Mondello on 12-13 May 2017. They are graded according to the GRADE grading system.
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Affiliation(s)
- Patrizia Burra
- Multivisceral Transplant Unit, University Hospital, Padova, Italy
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | | | - Riccardo Volpes
- Hepatology and Gastroenterology Unit, ISMETT-IRCCS, Palermo, Italy
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19
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The safety and efficacy of ledipasvir/sofosbuvir with or without ribavirin in the treatment of orthotopic liver transplant recipients with recurrent hepatitis C: real-world data. Eur J Gastroenterol Hepatol 2018; 30:761-765. [PMID: 29481384 DOI: 10.1097/meg.0000000000001101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Recurrent hepatitis C (RHC) in orthotopic liver transplantation (OLT) population is associated with accelerated rates of fibrosis, low efficacy and decreased tolerability with traditional therapies. AIM The aim of this study was to evaluate the safety and efficacy of ledipasvir/sofosbuvir (LED/SOF) with or without ribavirin (RBV) in OLT patients with RHC. PATIENTS AND METHODS Patients at least 3 months post-OLT and with documented RHC were treated with LED/SOF with or without RBV for either 12 or 24 weeks. End-of-treatment and sustained virological response 12 weeks after the completion of treatment were documented. Patients were closely monitored for treatment-related adverse effects and the potential need for adjustment in their immunosuppression. RESULTS Seventy-one patients were included in the study. Median age was 62 years. Median time from OLT was 55 months. Twenty-six (36.6%) patients were treatment-naive and 45 (63.4%) had previously failed interferon-based therapies. The majority of patients (57.7%) had stage F0-F2 fibrosis. Sixty-seven (94.3%) patients completed 12 weeks of LED/SOF with RBV, three patients completed 12 or 24 weeks of LED/SOF without RBV, and one patient completed only 8 weeks of LED/SOF without RBV owing to severe allograft dysfunction. Sustained virological response was near universal in our cohort (98.5%) regardless of genotype, fibrosis stage, and regimen or treatment duration. Most commonly reported side effects were malaise and gastrointestinal upset. No patient required adjustment in immunosuppression and no episodes of rejection were documented during treatment. CONCLUSION The combination of LED/SOF with RBV for 12 weeks or LED/SOF for 24 weeks is very effective and safe in treating OLT recipients with RHC.
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20
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Grottenthaler JM, Werner CR, Steurer M, Spengler U, Berg T, Engelmann C, Wedemeyer H, von Hahn T, Stremmel W, Pathil A, Seybold U, Schott E, Blessin U, Sarrazin C, Welker MW, Harrer E, Scholten S, Hinterleitner C, Lauer UM, Malek NP, Berg CP. Successful direct acting antiviral (DAA) treatment of HCV/HIV-coinfected patients before and after liver transplantation. PLoS One 2018; 13:e0197544. [PMID: 29874250 PMCID: PMC5991346 DOI: 10.1371/journal.pone.0197544] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/03/2018] [Indexed: 12/15/2022] Open
Abstract
Objectives The aim of this multicenter retrospective study was to investigate safety and efficacy of direct acting antiviral (DAA) treatment in the rare subgroup of patients with HCV/HIV-coinfection and advanced liver cirrhosis on the liver transplant waiting list or after liver transplantation, respectively. Methods When contacting 54 German liver centers (including all 23 German liver transplant centers), 12 HCV/HIV-coinfected patients on antiretroviral combination therapy were reported having received additional DAA therapy while being on the waiting list for liver transplantation (patient characteristics: Child-Pugh A (n = 6), B (n = 5), C (n = 1); MELD range 7–21; HCC (n = 2); HCV genotype 1a (n = 8), 1b (n = 2), 4 (n = 2)). Furthermore, 2 HCV/HIV-coinfected patients were denoted having received DAA therapy after liver transplantation (characteristics: HCV genotype 1a (n = 1), 4 (n = 1)). Results Applied DAA regimens were SOF/DAC (n = 7), SOF/LDV/RBV (n = 3), SOF/RBV (n = 3), PTV/r/OBV/DSV (n = 1), or PTV/r/OBV/DSV/RBV (n = 1), respectively. All patients achieved SVR 12, in the end. In one patient, HCV relapse occurred after 24 weeks of SOF/DAC therapy; subsequent treatment with 12 weeks PTV/r/OBV/DSV achieved SVR 12. One patient underwent liver transplantation while on DAA treatment. Analysis of liver function revealed either stable parameters or even significant improvement during DAA therapy and in follow-up. MELD scores were found to improve in 9/13 therapies in patients on the waiting list for liver transplantation; in only 2 patients a moderate increase of MELD scores persisted at the end of follow-up. Conclusion DAA treatment was safe and highly effective in this nation-wide cohort of patients with HCV/HIV-coinfection awaiting liver transplantation or being transplanted.
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Affiliation(s)
- Julia M. Grottenthaler
- Department of Gastroenterology, Hepatology, and Infectiology, University Hospital Tuebingen, Tuebingen, Germany
- German Center for Infection Research (DZIF) partner site, Tuebingen, Bonn, Hannover, Heidelberg, Munich, Germany
| | - Christoph R. Werner
- Department of Gastroenterology, Hepatology, and Infectiology, University Hospital Tuebingen, Tuebingen, Germany
- German Center for Infection Research (DZIF) partner site, Tuebingen, Bonn, Hannover, Heidelberg, Munich, Germany
| | - Martina Steurer
- Department of Gastroenterology, Hepatology, and Infectiology, University Hospital Tuebingen, Tuebingen, Germany
- German Center for Infection Research (DZIF) partner site, Tuebingen, Bonn, Hannover, Heidelberg, Munich, Germany
| | - Ulrich Spengler
- German Center for Infection Research (DZIF) partner site, Tuebingen, Bonn, Hannover, Heidelberg, Munich, Germany
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Thomas Berg
- Division of Gastroenterology and Hepatology, University Hospital Leipzig, Leipzig, Germany
| | - Cornelius Engelmann
- Division of Gastroenterology and Hepatology, University Hospital Leipzig, Leipzig, Germany
| | - Heiner Wedemeyer
- German Center for Infection Research (DZIF) partner site, Tuebingen, Bonn, Hannover, Heidelberg, Munich, Germany
- Department of Gastroenterology, Hepatology, and Endocrinology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Thomas von Hahn
- German Center for Infection Research (DZIF) partner site, Tuebingen, Bonn, Hannover, Heidelberg, Munich, Germany
- Department of Gastroenterology, Hepatology, and Endocrinology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Wolfgang Stremmel
- German Center for Infection Research (DZIF) partner site, Tuebingen, Bonn, Hannover, Heidelberg, Munich, Germany
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Anita Pathil
- German Center for Infection Research (DZIF) partner site, Tuebingen, Bonn, Hannover, Heidelberg, Munich, Germany
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Ulrich Seybold
- German Center for Infection Research (DZIF) partner site, Tuebingen, Bonn, Hannover, Heidelberg, Munich, Germany
- Division of Infectious Diseases, Medizinische Poliklinik-Innenstadt, University of Munich, Munich, Germany
| | - Eckart Schott
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Usha Blessin
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Sarrazin
- Department of Gastroenterology and Hepatology, University Hospital Frankfurt, Frankfurt, Germany
| | - Martin-Walter Welker
- Department of Gastroenterology and Hepatology, University Hospital Frankfurt, Frankfurt, Germany
| | - Ellen Harrer
- Department of Internal Medicine 3, Institute of Clinical Immunology, University Hospital Erlangen, Erlangen, Germany
| | | | - Clemens Hinterleitner
- German Center for Infection Research (DZIF) partner site, Tuebingen, Bonn, Hannover, Heidelberg, Munich, Germany
- Department of Medical Oncology, Haematology, Immunology, Rheumatology and Pulmology, University Hospital Tuebingen, Tuebingen, Germany
| | - Ulrich M. Lauer
- German Center for Infection Research (DZIF) partner site, Tuebingen, Bonn, Hannover, Heidelberg, Munich, Germany
- Department of Clinical Tumor Biology, University Hospital Tuebingen, Tuebingen, Germany
| | - Nisar P. Malek
- Department of Gastroenterology, Hepatology, and Infectiology, University Hospital Tuebingen, Tuebingen, Germany
- German Center for Infection Research (DZIF) partner site, Tuebingen, Bonn, Hannover, Heidelberg, Munich, Germany
| | - Christoph P. Berg
- Department of Gastroenterology, Hepatology, and Infectiology, University Hospital Tuebingen, Tuebingen, Germany
- German Center for Infection Research (DZIF) partner site, Tuebingen, Bonn, Hannover, Heidelberg, Munich, Germany
- * E-mail:
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Efficacy And Safety of Sofosbuvir Based Regimens For Treatment of Hepatitis C Recurrence After Living Donor Liver Transplantation: An Experience From India. J Clin Exp Hepatol 2018; 8:121-124. [PMID: 29892173 PMCID: PMC5992320 DOI: 10.1016/j.jceh.2017.08.004] [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: 06/07/2017] [Accepted: 08/24/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Results of Sofosbuvir based regimens for hepatitis C (HCV) recurrence after liver transplantation are available from well-designed clinical trials. Most of the data is from deceased donor liver transplant (DDLT) setting, and data on "real world" experience for HCV recurrence after living donor liver transplantation (LDLT) is limited. MATERIAL AND METHODS Consecutive 78 patients who completed Sofosbuvir based HCV treatment after liver transplantation were included. Following Sofosbuvir based regimens were used; Sofosbuvir + Ribavirin (n = 58), Sofosbuvir + Ledipasvir ± Ribavirin (n = 5), Sofosbuvir + Daclatasvir ± Ribavirin (n = 15). Treatment was given for 12 weeks (triple therapy) or 24 weeks (dual therapy). RESULTS A total of 74/78 (94.8%) patients achieved end of treatment response (ETR) while 4 did not achieve ETR. A total of 68/76 (89.4%) patients achieved sustained virological response at 12 weeks (SVR12). while 2 are waiting for 12 weeks follow up after ETR. Twelve patients had history of failed previous treatment with Peginterferon and Ribavirin after LDLT, all these patients achieved ETR and 11/12 had SVR12. There was no statistical difference in response rates between genotype 1 or 3. Eighteen patients (16 on Ribavirin) had hemoglobin < 8 g/dl; two patients complained fatigue in absence of anemia. CONCLUSION Sofosbuvir based regimens are safe and highly effective in treatment of HCV recurrence after LDLT.
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Anty R, Favre G, Coilly A, Rossignol E, Houssel-Debry P, Duvoux C, De Ledinghen V, Di Martino V, Leroy V, Radenne S, Kamar N, Canva V, D'Alteroche L, Durand F, Dumortier J, Lebray P, Besch C, Tran A, Canivet CM, Botta-Fridlund D, Montialoux H, Moreno C, Conti F, Silvain C, Perré P, Habersetzer F, Abergel A, Debette-Gratien M, Dharancy S, Esnault VLM, Fougerou-Leurent C, Cagnot C, Diallo A, Veislinger A, Danjou H, Samuel D, Pageaux GP, Duclos-Vallée JC. Safety of sofosbuvir-based regimens after liver transplantation: longitudinal assessment of renal function in the prospective ANRS CO23 CUPILT study. Aliment Pharmacol Ther 2018; 47:1682-1689. [PMID: 29665081 DOI: 10.1111/apt.14639] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/09/2018] [Accepted: 03/07/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND In liver transplant recipients with hepatitis C virus recurrence, there is concern about renal safety of sofosbuvir-based regimens. Changes in serum creatinine or in the estimated glomerular filtration rate (eGFR) under treatment are used to look for possible renal toxicity. However, serum creatinine and eGFR are highly variable. AIM To analyse renal function trajectory with numerous assays of serum creatinine over a long period of time. METHODS In a multicentre cohort of 139 patients, the eGFR was obtained from serum creatinine using the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation. Slopes of eGFR were defined as a change in eGFR during a period divided by time. Pre-treatment, on-treatment and post-treatment periods were 9 months, 3-9 months and 4.5 months. Interactions between eGFR slopes and the pre-treatment eGFR, use of ribavirin or mycophenolate mofetil, and stage of fibrosis were addressed. On-treatment eGFR slopes were separated in tertiles. Pre- and post-treatment eGFR slopes were compared globally and according to tertiles. RESULTS The post-treatment eGFR slope was significantly better than pre-treatment eGFR slope (+0.18 (IQR -0.76 to +1.32) vs -0.11 (IQR -1.01 to +0.73) mL/min/1.73 m2 /month, P = 0.03) independently of the pre-treatment eGFR (P = 0.99), ribavirin administration (P = 0.26), mycophenolate mofetil administration (P = 0.51) and stage of fibrosis (F3 and F4 vs lower stages, P = 0.18; F4 vs lower stages, P = 0.08; F4 Child-Pugh B and C vs lower stages, P = 0.38). Tertiles of on-treatment eGFR slopes were -1.71 (IQR -2.54 to -1.48), -0.78 (IQR -1.03 to -0.36) and +0.75 (IQR +0.28 to +1.47) mL/min/1.73 m2 /month. Pre- and post-treatment eGFR slopes were not significantly different according to tertiles (respectively, P = 0.34, 0.08, 0.73). CONCLUSION The eGFR varies during treatment and gives a confusing picture of the renal safety of sofosbuvir-based regimens. In contrast, longitudinal assessment of the eGFR shows a rising trajectory over longer time, meaning that these therapies are safe for the kidneys in our cohort of liver transplant recipients.
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23
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Abdel-Moneim A, Aboud A, Abdel-Gabaar M, Zanaty MI, Ramadan M. Efficacy and safety of sofosbuvir plus daclatasvir with or without ribavirin: large real-life results of patients with chronic hepatitis C genotype 4. Hepatol Int 2018; 12:348-355. [PMID: 29754329 DOI: 10.1007/s12072-018-9868-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 04/23/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Clinical studies evaluating the efficacy of daclatasvir (DCV) for treatment of chronic hepatitis C virus (HCV) genotype 4 (GT4) infection are scarce. This study aims to evaluate the efficacy and safety of DCV plus sofosbuvir (SOF) with or without ribavirin (RBV) for treatment of Egyptian patients infected with HCV GT4. METHODS Between April 2016 and March of 2017, a large cohort of 946 patients with chronic HCV GT4 was enrolled for completing the treatment. Patients were classified into two groups: group 1 (easy to treat) was treated with a dual therapy of SOF/DCV daily for 12 weeks and group 2 (difficult to treat) was treated with a triple therapy of SOF/DCV/RBV daily for 12 weeks. Efficacy and safety of the treatments were estimated, and baseline characters associated with sustained virological response at 12 weeks post-treatment (SVR12) were investigated. RESULTS Among the patient's cohort, SVR12 was achieved by 94% (891/946) in the overall patients, by 95% (718/758) in the easy-to-treat group, and by 92% (173/188) in the difficult-to-treat group. The most common adverse events recorded were fatigue, headache, nausea, asthenia, and gastrointestinal troubles. No patient discontinued treatment due to severe adverse events. CONCLUSION The findings from the present study suggested that SOF/DCV (with or without RBV) regimen exhibited high effectiveness, was well tolerated in the treatment of chronic HCV GT 4, and revealed itself as a better option for patients with advanced liver disease, making the eradication of HCV a more realistic target to achieve.
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Affiliation(s)
- Adel Abdel-Moneim
- Molecular Physiology Division, Faculty of Science, Beni-Suef University, Salah Salim St., Beni Suef, 62511, Egypt.
| | - Alaa Aboud
- Tropical Medicine Department, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Mohamed Abdel-Gabaar
- Biochemistry Division, Faculty of Science, Beni-Suef University, Beni Suef, Egypt
| | - Mohamed I Zanaty
- Biotechnology Department, Faculty of Postgraduate Studies for Advanced Science, Beni-Suef University, Beni Suef, Egypt
| | - Mohamed Ramadan
- Biochemistry Division, Faculty of Science, Beni-Suef University, Beni Suef, Egypt
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24
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Feldman SF, Lapidus N, Dorival C, Diallo A, Amri I, Fontaine H, Pol S, Carrat F. Signal detection on a patient cohort: A disproportionality analysis of the ANRS CO22 HEPATHER cohort to identify associations between direct acting antivirals and adverse events in patients with hepatitis C virus chronic infection. Pharmacoepidemiol Drug Saf 2018; 27:797-805. [PMID: 29749668 DOI: 10.1002/pds.4552] [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] [Received: 07/06/2017] [Revised: 01/11/2018] [Accepted: 04/05/2018] [Indexed: 11/08/2022]
Abstract
PURPOSE Our aim was to explore a signal detection method for early identification of potential adverse drug reactions (ADRs) in a patient cohort. METHODS ANRS CO22 HEPATHER is a French multicentre prospective observational cohort started in 2012. The cohort includes patients with chronic hepatitis C virus (HCV) infection with reports of all adverse events (AEs) occurring in patients exposed to HCV drugs. We applied a disproportionality method, which calculated a measure of association, the Bayesian information component (IC), for each drug-AE pair. Information components were continuously updated and a positive drug-AE association was detected when the lower limit of an IC 95% credible interval (95% CI) exceeded 0. We illustrate how the method could result in timely detection of photosensitivity reaction with simeprevir use. RESULTS By August 28, 2016, 6600 patients with HCV infection had been treated or were undergoing current HCV treatment, and 3464 experienced at least one AE for a total of 12 720 reported AEs. We detected 52 positive drug-AE associations, including 44 that were known ADRs based on the summary of product characteristics. The association between simeprevir and photosensitivity reaction was detected on June 4, 2014. At this date, 68 patients had received simeprevir and 6 photosensitivity reaction (4 during simeprevir treatment) had been reported for an estimated IC of 1.90, 95% CI, 0.20-3.61. CONCLUSIONS The disproportionality method can help with early detection of potential ADRs in patient cohorts. Detected associations need to be confirmed by a review of clinical data.
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Affiliation(s)
- Sarah F Feldman
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Unité de Santé Publique, Paris, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Nathanaël Lapidus
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Unité de Santé Publique, Paris, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Céline Dorival
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Alpha Diallo
- ANRS (France REcherche Nord&sud Sida-hiv Hépatites), Clinical trial safety and Public Health, Paris, France
| | - Imane Amri
- ANRS (France REcherche Nord&sud Sida-hiv Hépatites), Clinical trial safety and Public Health, Paris, France
| | - Hélène Fontaine
- Université Paris Descartes; APHP, Unité d'Hépatologie, Hôpital Cochin; INSERM U-818 et USM20, Institut Pasteur, Paris, France
| | - Stanislas Pol
- Université Paris Descartes; APHP, Unité d'Hépatologie, Hôpital Cochin; INSERM U-818 et USM20, Institut Pasteur, Paris, France
| | - Fabrice Carrat
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Unité de Santé Publique, Paris, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
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25
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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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26
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Puchades Renau L, Berenguer M. Introduction to hepatitis C virus infection: Overview and history of hepatitis C virus therapies. Hemodial Int 2018; 22 Suppl 1:S8-S21. [DOI: 10.1111/hdi.12647] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Lorena Puchades Renau
- Department of Gastroenterology, Hepatology Unit & Instituto de Investigación La Fe; Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - Marina Berenguer
- Department of Gastroenterology, Hepatology Unit & Instituto de Investigación La Fe; Hospital Universitari i Politècnic La Fe; Valencia Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd); Valencia Spain
- School of Medicine; University of Valencia; Valencia Spain
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27
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Early treatment of recurrent hepatitis C virus infection after liver transplantation in the era of direct-acting antivirals, what we have learned till now? EGYPTIAN LIVER JOURNAL 2018. [DOI: 10.1097/01.elx.0000546496.60509.bf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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28
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Kwo P, Fried MW, Reddy KR, Soldevila-Pico C, Khemichian S, Darling J, Zamor PJ, Napoli AA, Anduze-Faris B, Brown RS. Daclatasvir and sofosbuvir treatment of decompensated liver disease or post-liver transplant hepatitis C virus recurrence in patients with advanced liver disease/cirrhosis in a real-world cohort. Hepatol Commun 2018; 2:354-363. [PMID: 29619415 PMCID: PMC5880197 DOI: 10.1002/hep4.1156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/08/2017] [Accepted: 01/11/2018] [Indexed: 12/12/2022] Open
Abstract
We report the findings of an early access program providing treatment for chronic hepatitis C virus infection (any genotype) with daclatasvir and sofosbuvir with/without ribavirin to patients with Child‐Pugh class C cirrhosis or prior liver transplant recipients with recurrent hepatitis C virus infection and advanced fibrosis/cirrhosis. Patients had <12‐month life expectancies per the local investigator. Patients received daclatasvir 60 mg and sofosbuvir 400 mg once daily, with/without ribavirin, for 24 weeks. Sustained virologic response (SVR) at posttreatment week 12 (SVR12) was measured. Assessments adhered to local standards. One patient (prior Child‐Pugh class C who improved to class B) enrolled by exemption was included in the overall data but not the class C cohort efficacy/safety data. Of the 77 treated patients, including 62 liver transplant recipients (genotype 1, n = 43, 69%; genotype 3, n = 16, 26%) and 14 patients with Child‐Pugh class C cirrhosis (genotype 1, n = 4, 29%; genotype 3, n = 10, 71%), 63 (82%) completed treatment. SVR12 rates by modified intention‐to‐treat analysis (excluding nonvirologic failures lost to follow‐up and withdrawal [consent/no reason]) in the overall, liver transplant, and Child‐Pugh class C cohorts were 84% (n = 64/76), 90% (n = 56/62), and 62% (n = 8/13), respectively. Rates increased to 96% (n = 64/67), 97% (n = 56/58), and 89% (n = 8/9), respectively, in patients with available virologic data (including early discontinuations); 22/23 patients with genotype 3 (96%) achieved SVR12. Single cases of virologic nonresponse and relapse (both in liver transplant recipients with genotype 1) and viral breakthrough (Child‐Pugh class C; genotype 3) occurred. Six patients died, 10 had adverse events leading to discontinuation, and 30 experienced serious adverse events. Conclusion: Daclatasvir plus sofosbuvir, with/without ribavirin, provided high SVR12 rates and was generally well tolerated in patients with life‐threatening disease and high unmet needs. (Hepatology Communications 2018;2:354‐363)
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Affiliation(s)
- Paul Kwo
- Division of Gastroenterology and Hepatology Stanford University School of Medicine Palo Alto CA
| | - Michael W Fried
- Department of Medicine University of North Carolina School of Medicine Chapel Hill NC
| | - K Rajender Reddy
- Division of Gastroenterology and Hepatology University of Pennsylvania Philadelphia PA
| | | | - Saro Khemichian
- Department of Medicine, Keck School of Medicine University of Southern California Los Angeles CA
| | - Jama Darling
- Department of Medicine University of North Carolina School of Medicine Chapel Hill NC
| | | | | | | | - Robert S Brown
- Department of Medicine Weill Cornell Medicine New York NY
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29
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International Liver Transplantation Society Consensus Statement on Hepatitis C Management in Liver Transplant Recipients. Transplantation 2018; 101:956-967. [PMID: 28437388 DOI: 10.1097/tp.0000000000001704] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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30
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Omar H, El Akel W, Elbaz T, El Kassas M, Elsaeed K, El Shazly H, Said M, Yousif M, Gomaa AA, Nasr A, AbdAllah M, Korany M, Ismail SA, Shaker MK, Doss W, Esmat G, Waked I, El Shazly Y. Generic daclatasvir plus sofosbuvir, with or without ribavirin, in treatment of chronic hepatitis C: real-world results from 18 378 patients in Egypt. Aliment Pharmacol Ther 2018; 47:421-431. [PMID: 29193226 DOI: 10.1111/apt.14428] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/22/2017] [Accepted: 10/30/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Treatment of chronic hepatitis C using combination of sofosbuvir (SOF) and daclatasvir (DCV) was used in several clinical trials and multicentre studies, which were somewhat limited to genotypes 1-3. The national program in Egypt is using SOF-DCV combination for large scale treatment. AIM To assess the efficacy and safety of combined SOF-DCV in treating patients with HCV-G4 in a real-world setting. METHODS Data and outcome of chronic HCV patients who were treated for 12 weeks with generic medications: DCV 60 mg plus SOF 400 mg ± ribavirin (RBV) within the national hepatitis C treatment program in Egypt are presented. Treatment-naïve patients without cirrhosis were treated without RBV, and those who had cirrhosis or were treatment-experienced (interferon experienced or SOF experienced) received RBV. Efficacy and safety were assessed, and baseline factors associated with sustained virological response at post-treatment week 12 (SVR12) were explored. RESULTS During the first 2 months of the programme, 18 378 patients with HCV-G4 started treatment with SOF-DCV with or without RBV. Overall, 95.1% achieved SVR12 (95.4% among patients treated without RBV and 94.7% for patients treated with RBV, P = .32). Treatment was prematurely discontinued in only 1.5% of patients. The most common events leading to discontinuation were patient withdrawal (n = 76) and pregnancy (n = 5). Five deaths occurred within this group. CONCLUSIONS Real-world experience of generic SOF-DCV in patients with chronic HCV-G4 proved to be safe and associated with a high SVR12 rate, in patients with different stages of fibrosis.
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Affiliation(s)
- H Omar
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - W El Akel
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - T Elbaz
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M El Kassas
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - K Elsaeed
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - H El Shazly
- National Liver Institute, Menoufiya University, Shebeen EL Kom, Egypt
| | - M Said
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - M Yousif
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - A A Gomaa
- Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - A Nasr
- Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - M Korany
- National Committee for Control of Viral Hepatitis, Cairo, Egypt
| | - S A Ismail
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - M K Shaker
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - W Doss
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - G Esmat
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - I Waked
- National Liver Institute, Menoufiya University, Shebeen EL Kom, Egypt
| | - Y El Shazly
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
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31
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Lionetti R, Calvaruso V, Piccolo P, Mancusi RL, Mazzarelli C, Fagiuoli S, Montalbano M, Lenci I, Carrai P, Guaraldi G, Visco-Comandini U, Milana M, Biolato M, Loiacono L, Valente G, Craxì A, Angelico M, D'offizi G. Sofosbuvir plus daclatasvir with or without ribavirin is safe and effective for post-transplant hepatitis C recurrence and severe fibrosis and cirrhosis: A prospective study. Clin Transplant 2017; 32. [PMID: 29193356 DOI: 10.1111/ctr.13165] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND In 2012, an Italian Named Patient Program began for hepatitis C virus (HCV)-infected liver transplant (LT) recipients with advanced fibrosis, before approval of direct antiviral agents (DAA), to benefit severely ill patients. The aim of this "real-life" study was to assess treatment efficacy and safety with an extended course of daclatasvir (DCV) plus sofosbuvir (SOF) with or without ribavirin (RBV). METHODS All HCV LT recipients with severe fibrosis in 15 Italian transplant centers were treated with DCV+SOF±RBV for 24 weeks; sustained virological response was assessed at 12 weeks post-treatment (SVR12). RESULTS Eighty-seven patients were enrolled (75.9% males, mean age 58.4 ± 7.2 years, 83.9% genotype 1, 81.6% cirrhosis); 52 (59.8%) received RBV. Overall, 79 obtained SVR12 (90.8%): 100% in F3 and 88.7% in cirrhotics (91.5% in Child-Pugh A, 83.3% in Child-Pugh B and C). According to the treatment group, SVR was 80% in DCV + SOF group and 98.1% in SOF + DCV + RBV. Two virological relapses occurred during follow-up in cirrhotic patients who received DCV + SOF. Four cirrhotic patients in DCV + SOF group and 1 in DCV + SOF + RBV group died on treatment. CONCLUSION An extended course of SOF plus DCV for 24 weeks, with or without RBV, is effective and well tolerated for the treatment of post-LT HCV recurrence with severe fibrosis.
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Affiliation(s)
- Raffaella Lionetti
- Infectious and Liver Diseases, Lazzaro Spallanzani National Infectious Disease Institute, Rome, Italy
| | | | - Paola Piccolo
- Department of Internal Medicine, San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy.,Hepatology Unit, Tor Vergata University, Rome, Italy
| | | | - Chiara Mazzarelli
- Gastroenterology and Liver Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Stefano Fagiuoli
- Gastroenterology and Liver Unit, San Giovanni XXIII Hospital, Bergamo, Italy
| | - Marzia Montalbano
- Infectious and Liver Diseases, Lazzaro Spallanzani National Infectious Disease Institute, Rome, Italy
| | - Ilaria Lenci
- Hepatology Unit, Tor Vergata University, Rome, Italy
| | - Paola Carrai
- Liver Transplantation Unit, Pisa Hospital, Pisa, Italy
| | | | - Ubaldo Visco-Comandini
- Infectious and Liver Diseases, Lazzaro Spallanzani National Infectious Disease Institute, Rome, Italy
| | | | - Marco Biolato
- Liver Transplant Medicine, Fondazione Policlinico Gemelli Catholic University, Rome, Italy
| | - Laura Loiacono
- Infectious and Liver Diseases, Lazzaro Spallanzani National Infectious Disease Institute, Rome, Italy
| | | | - Antonio Craxì
- Gastroenterology Unit, University of Palermo, Palermo, Italy
| | | | - Gianpiero D'offizi
- Infectious and Liver Diseases, Lazzaro Spallanzani National Infectious Disease Institute, Rome, Italy
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32
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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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33
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Levitsky J, Formica RN, Bloom RD, Charlton M, Curry M, Friedewald J, Friedman J, Goldberg D, Hall S, Ison M, Kaiser T, Klassen D, Klintmalm G, Kobashigawa J, Liapakis A, O'Conner K, Reese P, Stewart D, Terrault N, Theodoropoulos N, Trotter J, Verna E, Volk M. The American Society of Transplantation Consensus Conference on the Use of Hepatitis C Viremic Donors in Solid Organ Transplantation. Am J Transplant 2017; 17:2790-2802. [PMID: 28556422 DOI: 10.1111/ajt.14381] [Citation(s) in RCA: 236] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/12/2017] [Accepted: 05/18/2017] [Indexed: 01/25/2023]
Abstract
The availability of direct-acting antiviral agents for the treatment of hepatitis C virus (HCV) infection has resulted in a profound shift in the approach to the management of this infection. These changes have affected the practice of solid organ transplantation by altering the framework by which patients with end-stage organ disease are managed and receive organ transplants. The high level of safety and efficacy of these medications in patients with chronic HCV infection provides the opportunity to explore their use in the setting of transplanting organs from HCV-viremic patients into non-HCV-viremic recipients. Because these organs are frequently discarded and typically come from younger donors, this approach has the potential to save lives on the solid organ transplant waitlist. Therefore, an urgent need exists for prospective research protocols that study the risk versus benefit of using organs for hepatitis C-infected donors. In response to this rapidly changing practice and the need for scientific study and consensus, the American Society of Transplantation convened a meeting of experts to review current data and develop the framework for the study of using HCV viremic organs in solid organ transplantation.
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Affiliation(s)
| | | | - R D Bloom
- University of Pennsylvania, Philadelphia, PA
| | - M Charlton
- Intermountain Medical Center, Salt Lake City, UT
| | - M Curry
- Beth Israel Deaconess Medical Center, Boston, MA
| | | | - J Friedman
- Optum Population Health Solutions, Minneapolis, MN
| | - D Goldberg
- University of Pennsylvania, Philadelphia, PA
| | - S Hall
- Baylor University Medical Center, Dallas, TX
| | - M Ison
- Northwestern University, Chicago, IL
| | - T Kaiser
- University of Cincinnati, Cincinnati, OH
| | - D Klassen
- United Network of Organ Sharing, Richmond, VA
| | - G Klintmalm
- Baylor University Medical Center, Dallas, TX
| | | | | | | | - P Reese
- University of Pennsylvania, Philadelphia, PA
| | - D Stewart
- United Network of Organ Sharing, Richmond, VA
| | - N Terrault
- University of California San Francisco, San Francisco, CA
| | | | - J Trotter
- Baylor University Medical Center, Dallas, TX
| | - E Verna
- Columbia University, New York, NY
| | - M Volk
- Loma Linda University, San Diego, CA
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34
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Burra P, Zanetto A. Filling the gap between clinical trials and real life in the treatment of severe HCV recurrence after liver transplantation. Transpl Int 2017; 30:239-242. [PMID: 28102906 DOI: 10.1111/tri.12917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 01/12/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Alberto Zanetto
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
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35
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Treatment with sofosbuvir and ledipasvir without ribavirin for 12 weeks is highly effective for recurrent hepatitis C virus genotype 1b infection after living donor liver transplantation: a Japanese multicenter experience. J Gastroenterol 2017; 52:986-991. [PMID: 28138756 DOI: 10.1007/s00535-017-1310-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/10/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND The optimal therapy for recurrent hepatitis C virus (HCV) infection after liver transplantation has not yet been established. This study aimed to clarify the efficacy and safety of interferon-free therapy with sofosbuvir and ledipasvir without ribavirin for 12 weeks in Japanese patients with HCV genotype 1b infection after living donor liver transplantation. METHODS A cohort study of living donor liver transplant recipients with recurrent HCV genotype 1b infection treated with sofosbuvir (400 mg/day) and ledipasvir (90 mg/day) was performed at six liver transplant centers in Japan. RESULTS Fifty-four patients were treated with sofosbuvir and ledipasvir. Thirty-eight patients (70%) were treatment experienced, including 17 patients who had undergone prior direct-acting-antiviral-based triple therapy. Ten patients had resistance-associated substitutions at L31 or Y93 in the NS5A region of the HCV genome. Fifty-three patients completed the 12-week treatment protocol; treatment was discontinued in one patient who developed pneumonia at 4 weeks and died thereafter. All 53 patients who completed the treatment regimen achieved a sustained virological response 12 weeks after completion of treatment. Treatment was well tolerated in most patients, but seven patients developed serious adverse events, including hemorrhagic duodenal ulcers (n = 3), infection (n = 2), pleural effusion (n = 1), and alveolar hemorrhage (n = 1). CONCLUSIONS Sofosbuvir and ledipasvir treatment without ribavirin for 12 weeks was highly effective in achieving a sustained virological response in Japanese patients who developed recurrent HCV genotype 1b infection after living donor liver transplantation.
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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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Herzer K, Welzel TM, Spengler U, Hinrichsen H, Klinker H, Berg T, Ferenci P, Peck-Radosavljevic M, Inderson A, Zhao Y, Jimenez-Exposito MJ, Zeuzem S. Real-world experience with daclatasvir plus sofosbuvir ± ribavirin for post-liver transplant HCV recurrence and severe liver disease. Transpl Int 2017; 30:243-255. [PMID: 28012215 DOI: 10.1111/tri.12910] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/18/2016] [Accepted: 12/13/2016] [Indexed: 02/06/2023]
Abstract
Optimizing therapy of post-transplant HCV recurrence remains important, especially in advanced liver disease. We evaluated daclatasvir (DCV) plus sofosbuvir (SOF), with or without ribavirin (RBV), in patients with post-liver transplant recurrence in a real-world European cohort at high risk of decompensation or death within 12 months. Recommended treatment was DCV 60 mg plus SOF 400 mg once daily for 24 weeks; RBV use/shorter treatment duration was at physicians' discretion. Patients (N = 87) were 70% male, 93% white, and mostly infected with HCV genotypes 1b (48%), 1a (32%), or 3 (9%); 37 (43%) had cirrhosis (16 decompensated), five had fibrosing cholestatic hepatitis. Sustained virologic response at post-treatment week 12 (SVR12) was 94% (80/85) in a modified intention-to-treat analysis: 95% (58/61) without RBV and 92% (22/24) with RBV, with no virologic failures. SVR12 was 100% (80/80) in an as-observed analysis excluding five nonvirologic failures. Four patients (5%) discontinued therapy for adverse events (AEs); 16 (18%) experienced serious AEs. One patient died on treatment and five during follow-up. Most AEs were associated with advanced liver disease and unrelated to therapy. No clinically significant drug-drug interactions were observed. DCV + SOF ± RBV was well tolerated and achieved high SVR12 (94%) in patients with post-transplant HCV recurrence, including patients with severe liver disease.
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Affiliation(s)
| | - Tania M Welzel
- Universitätsklinikum der Johann Wolfgang Goethe Universität, Frankfurt, Germany
| | | | | | | | - Thomas Berg
- Universitätsklinikum Leipzig, Leipzig, Germany
| | | | - Markus Peck-Radosavljevic
- Medical University of Vienna, Vienna, Austria.,Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Akin Inderson
- Leiden University Medical Center, Leiden, The Netherlands
| | - Yue Zhao
- Bristol-Myers Squibb, Princeton, NJ, USA
| | | | - Stefan Zeuzem
- Universitätsklinikum der Johann Wolfgang Goethe Universität, Frankfurt, Germany
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Bernuth S, Grimm D, Vollmar J, Darstein F, Mittler J, Heise M, Hoppe-Lotichius M, Galle PR, Lang H, Zimmermann T. Efficacy and safety of direct-acting antiviral therapy in previous hard-to-treat patients with recurrent hepatitis C virus infection after liver transplantation: a real-world cohort. Drug Des Devel Ther 2017; 11:2131-2138. [PMID: 28744104 PMCID: PMC5513830 DOI: 10.2147/dddt.s139837] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Recurrent hepatitis C virus (HCV) infection after liver transplantation (LT) has been a frequent and relevant problem in the past two decades. This analysis evaluated the efficacy and safety of new interferon (IFN)-free direct-acting antiviral (DAA) therapies in a large real-world cohort of HCV patients after LT. METHODS We retrospectively analyzed a cohort of 157 patients infected with HCV who underwent deceased donor LT between 1997 and 2014. Patient survival, outcome, and side effects of antiviral therapy were assessed. RESULTS Survival with recurrent HCV genotype 1 (GT1) infection was inferior to other HCV GTs (P=0.01). The overall sustained virological response (SVR) rate with new DAA therapy was 94.6% (n=37). Patients with both GT1 and other GTs reached SVR rates >90%. We noticed a few side effects, mainly caused by ribavirin, and only one discontinuation in DAA-treated patients. CONCLUSION DAA therapy was effective and safe in previous hard-to-treat patients after LT in this real-world cohort.
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Affiliation(s)
| | - Daniel Grimm
- First Department of Internal Medicine, Transplant Hepatology
| | - Johanna Vollmar
- First Department of Internal Medicine, Transplant Hepatology
| | - Felix Darstein
- First Department of Internal Medicine, Transplant Hepatology
| | - Jens Mittler
- General-, Abdominal- and Transplant-Surgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Michael Heise
- General-, Abdominal- and Transplant-Surgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Maria Hoppe-Lotichius
- General-, Abdominal- and Transplant-Surgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Peter R Galle
- First Department of Internal Medicine, Transplant Hepatology
| | - Hauke Lang
- General-, Abdominal- and Transplant-Surgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Tim Zimmermann
- First Department of Internal Medicine, Transplant Hepatology
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Schmidt-Martin D, Elsharkawy AM. Editorial: is ribavirin needed in the treatment of post-transplant hepatitis C recurrence? Aliment Pharmacol Ther 2017. [PMID: 28621075 DOI: 10.1111/apt.14110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Saab S, Rheem J, Jimenez MA, Fong TM, Mai MH, Kachadoorian CA, Esmailzadeh NL, Bau SN, Kang S, Ramirez SD, Grotts J, Choi G, Durazo FA, El-Kabany MM, Han SHB, Busuttil RW. Effectiveness of Ledipasvir/Sofosbuvir with/without Ribavarin in Liver Transplant Recipients with Hepatitis C. J Clin Transl Hepatol 2017; 5:101-108. [PMID: 28660147 PMCID: PMC5472930 DOI: 10.14218/jcth.2016.00070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/26/2017] [Accepted: 04/03/2017] [Indexed: 12/16/2022] Open
Abstract
Background and Aims: Recurrent infection of hepatitis C virus (HCV) in liver transplant (LT) recipients is universal and associated with significant morbidity and mortality. Methods: We retrospectively evaluated the safety and efficacy of ledipasvir/sofosbuvir with and without ribavirin in LT recipients with recurrent genotype 1 hepatitis C. Results: Eighty-five LT recipients were treated for recurrent HCV with ledipasvir/sofosbuvirwith and without ribavirin for 12 or 24 weeks. The mean (± standard deviation [SD]) time from LT to treatment initiation was 68 (±71) months. The mean (± SD) age of the cohort was 63 (±8.6) years old. Most recipients were male (70%). Baseline alanine transaminase, total bilirubin, and HCV ribonucleic acid (RNA) values (± SD) were 76.8 (±126) mg/dL, 0.8 (±1.3) U/L, and 8,010,421.9 (±12,420,985) IU/mL, respectively. Five of 43 recipients who were treated with ribavirin required drug cessation due to side effects, with 4 of those being anemia complications. No recipient discontinued the ledipasvir/sofosbuvir. Eighty-one percent of recipients had undetectable viral levels at 4 weeks after starting therapy, and all recipients had complete viral suppression at the end of therapy. The sustained viral response at 12 weeks after completion of therapy was 94%. Conclusion : Ledipasvir and sofosbuvir with and without ribavirin therapy is an effective and well-tolerated interferon-free treatment for recurrent HCV infection after LT. Anemia is not uncommon in LT recipients receiving ribavirin.
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Affiliation(s)
- Sammy Saab
- Departments of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Departments of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Justin Rheem
- Department of Medicine at Harbor-University of California at Los Angeles Medical Center, Torrance, California, USA
| | - Melissa A. Jimenez
- Departments of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Tiffany M. Fong
- Departments of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Michelle H. Mai
- Departments of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Caterina A. Kachadoorian
- Departments of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Negin L. Esmailzadeh
- Departments of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Sherona N. Bau
- Departments of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Departments of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Susan Kang
- Departments of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Departments of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Samantha D. Ramirez
- Departments of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Jonathan Grotts
- Department of Biostatistics at the University of California at Los Angeles, Los Angeles, California, USA
| | - Gina Choi
- Departments of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Departments of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Francisco A. Durazo
- Departments of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Departments of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Mohammed M. El-Kabany
- Departments of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Departments of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Steven-Huy B. Han
- Departments of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Departments of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Ronald W. Busuttil
- Departments of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Departments of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
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Yu ML, Chen YL, Huang CF, Lin KH, Yeh ML, Huang CI, Hsieh MH, Lin ZY, Chen SC, Huang JF, Dai CY, Chuang WL. Paritaprevir/ritonavir/ombitasvir plus dasabuvir with ribavirin for treatment of recurrent chronic hepatitis C genotype 1 infection after liver transplantation: Real-world experience. J Formos Med Assoc 2017; 117:518-526. [PMID: 28662883 DOI: 10.1016/j.jfma.2017.06.006] [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: 04/16/2017] [Revised: 05/17/2017] [Accepted: 06/12/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND/AIMS The registered trial has demonstrated that paritaprevir/ritonavir/ombitasvir plus dasabuvir (PrOD) with ribavirin was effective for recurrent hepatitis C virus genotype 1 (HCV-1) infection after liver transplantation in patients with mild fibrosis; however, the real-world efficacy and safety of this regimen have not been determined. METHODS The efficacy (sustained virological response, SVR12, undetectable HCV RNA 12 weeks post-treatment) and safety were evaluated in 12 patients with recurrent HCV-1 infection after liver transplantation. RESULTS Nine patients were treated for 24 weeks, and three patients (two treatment-naïve patients and one interferon-intolerant patient) were treated for 12 weeks. HCV RNA was undetectable at treatment day 1, week 1, week 4, week 12, and at the end of treatment in 8.3% (n = 1), 25% (n = 3), 83.3% (n = 10), 100% (n = 12), and 100% (n = 12) of patients, respectively. All twelve patients achieved SVR12. Treatment was temporarily stopped in one patient because of leucopenia. The other patient with minimal fibrosis experienced an elevation in alanine aminotransferase concentration, which returned to normal levels after dose reduction. Seven (58.3%) patients required RBV dose reduction and two (16.7%) required transient RBV discontinuation during treatment. There were no serious adverse events, and most adverse events were related to ribavirin. No patient developed graft rejection or deterioration in hepatic or renal function during treatment. Treatment efficacy and safety were comparable between patients with and without advanced liver fibrosis. CONCLUSION PrOD plus ribavirin had a highly satisfactory real-world efficacy and safety profile in the treatment of recurrent HCV-1 infection after liver transplantation in Asian patients.
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Affiliation(s)
- Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Institute of Biomedical Sciences, National Sun Yat-Sen University, Taiwan; Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yao-Li Chen
- Transplantation Center, Third Xiangya Hospital of Central South University, Changsha, China; Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Feng Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Occupational Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuo-Hua Lin
- Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Ming-Lun Yeh
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-I Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Meng-Hsuan Hsieh
- Department of Preventive Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Zu-Yau Lin
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shinn-Cherng Chen
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jee-Fu Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Occupational Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Preventive Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Rezaee-Zavareh MS, Hesamizadeh K, Sharafi H, Alavian SM. Treatment of Hepatitis C Infection with Direct-Acting Antiviral Agents in Liver-Transplant Patients: A Systematic Review and Meta-Analysis. HEPATITIS MONTHLY 2017; 17. [DOI: 10.5812/hepatmon.12324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
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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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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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D'Ambrosio R, Degasperi E, Colombo M, Aghemo A. Direct-acting antivirals: the endgame for hepatitis C? Curr Opin Virol 2017; 24:31-37. [PMID: 28419938 DOI: 10.1016/j.coviro.2017.03.017] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/30/2017] [Indexed: 12/13/2022]
Abstract
Directly-acting antivirals (DAA) have finally allowed all patients to be potentially cured from chronic hepatitis C (HCV) infection. All-oral, Interferon (IFN)-free regimens are based upon the combination of molecules targeting different sites of the HCV replication process. Three classes of DAA exist: protease inhibitors (anti-NS3/4A), RNA-dependent polymerase inhibitors (anti-NS5B) and anti-NS5A inhibitors, which are characterized by different antiviral potency and barrier to resistance and therefore are usually combined in different treatment schedules. Treatment regimens are still largely dependent on HCV genotype and stage of liver disease, with duration ranging between 12 weeks and 24 weeks, while overall treatment efficacy has climbed to nearly 95% in most patient groups, including historically difficult-to-treat categories (HCV genotype 1, advanced liver disease). The elimination of IFN has allowed safe and efficacious treatment of patients formerly contraindicated to antiviral therapy, such as decompensated cirrhosis and solid organ transplant recipients. Availability of potent and safe antiviral drugs combined with improvement of worldwide access to treatment could finally lead to HCV elimination in the next decades.
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Affiliation(s)
- Roberta D'Ambrosio
- Division of Gastroenterology and Hepatology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Elisabetta Degasperi
- Division of Gastroenterology and Hepatology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Massimo Colombo
- Humanitas Clinical and Research Center, Humanitas Research Hospital, Rozzano, Italy
| | - Alessio Aghemo
- Division of Gastroenterology and Hepatology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
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Qu Y, Guo Y, Li T, Ye Q, Sun C, Wang L, Yang B. Efficacy and safety of sofosbuvir-based interferon-free therapies for hepatitis C in liver transplant recipients. J Gastroenterol Hepatol 2017; 32:740-748. [PMID: 27749979 DOI: 10.1111/jgh.13614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM The aim of this study is to assess the efficacy and safety of sofosbuvir-based interferon-free therapies in liver transplantation recipients with hepatitis C virus infection recurrence. METHODS A systematic literature search was conducted in PubMed, EMBASE, Web of Science, and CENTRAL on the Cochrane Library without time or language limitation. The search strategy used was "sofosbuvir AND transplantation." Sustained virologic response at 12 weeks after the end of treatment (SVR12) rate, incidence of serious adverse events (SAEs) and/or adverse events, discontinuation rate with 95% confidence intervals (CI) were pooled with random-effects model. RESULTS Twenty-two studies (1730 patients) were included for our meta-analysis. The pooled SVR12 rate was 90.1% (95% CI 86.4-93.4%, I2 = 81.6%). SVR12 rate was higher in patients with mild fibrosis than in patients with advanced fibrosis and cirrhosis (RR = 1.072, 95% CI 1.031-1.115, I2 = 3.6%). For patients with hepatitis C virus genotype 1, the pooled SVR12 rate was 91.9% (95% CI 89.2-94.2%, I2 = 53.3%). The pooled SAEs incidence was 8.3% (95% CI 5.6-11.5%, I2 = 78.4%). The pooled discontinuation rate because of adverse events or SAEs was 3.3% (95% CI 1.8-5.2%). CONCLUSIONS Sofosbuvir-based interferon-free therapy is an effective and well-tolerated treatment strategy for patients with hepatitis C virus infection recurrence after liver transplantation.
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Affiliation(s)
- Yundong Qu
- Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Ying Guo
- Department of Intensive Care Unit, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Tao Li
- Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Qian Ye
- Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Chao Sun
- Central Research Laboratory, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Lei Wang
- Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Baohua Yang
- Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, Shandong, China
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Current therapy for chronic hepatitis C: The role of direct-acting antivirals. Antiviral Res 2017; 142:83-122. [PMID: 28238877 PMCID: PMC7172984 DOI: 10.1016/j.antiviral.2017.02.014] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/07/2017] [Accepted: 02/22/2017] [Indexed: 12/12/2022]
Abstract
One of the most exciting developments in antiviral research has been the discovery of the direct-acting antivirals (DAAs) that effectively cure chronic hepatitis C virus (HCV) infections. Based on more than 100 clinical trials and real-world studies, we provide a comprehensive overview of FDA-approved therapies and newly discovered anti-HCV agents with a special focus on drug efficacy, mechanisms of action, and safety. We show that HCV drug development has advanced in multiple aspects: (i) interferon-based regimens were replaced by interferon-free regimens; (ii) genotype-specific drugs evolved to drugs for all HCV genotypes; (iii) therapies based upon multiple pills per day were simplified to a single pill per day; (iv) drug potency increased from moderate (∼60%) to high (>90%) levels of sustained virologic responses; (v) treatment durations were shortened from 48 to 12 or 8 weeks; and (vi) therapies could be administered orally regardless of prior treatment history and cirrhotic status. However, despite these remarkable achievements made in HCV drug discovery, challenges remain in the management of difficult-to-treat patients. HCV genotype-specific drugs evolve to pan-genotypic drugs. Drug potency increases from moderate (∼60%) to high (>90%) levels of sustained virologic response. Treatment durations are shortened from a 48-week to 12-week or 8-week period. HCV therapies based upon multiple pills per day are simplified to a single pill per day. HCV therapies are administered orally regardless of prior treatment history and cirrhotic status.
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Fontaine H, Maynard M, Bouix C, Carrieri MP, Botta-Fridlund D, D'Alteroche L, Conti F, Pageaux GP, Leroy V, Métivier S, Anty R, Durand F, Canva V, Vilotitch A, Lebray P, Alric L, Duvoux C, Petrov-Sanchez V, Beaulieux F, Wellems C, Paul C, Roque-Afonso AM, Roche B, Pradat P, Samuel D, Duclos-Vallée JC. Efficacy and safety of boceprevir-based triple therapy in HCV cirrhotic patients awaiting liver transplantation (ANRS HC29 BOCEPRETRANSPLANT). Clin Res Hepatol Gastroenterol 2017; 41:56-65. [PMID: 27554134 DOI: 10.1016/j.clinre.2016.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 06/14/2016] [Accepted: 06/24/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS In this French multicentre, open-label study, we analyzed the efficacy, safety and patient-reported outcomes of a boceprevir-based triple therapy in HCV genotype 1 cirrhotic patients awaiting liver transplantation (LT). METHODS Patients received PEG-IFN/ribavirin (RBV) for 48 weeks (W) and boceprevir from W4 to W48 or until LT. RESULTS Fifty-one patients (80% males, median age: 56 years) were included. Fifty-seven percent had hepatocellular carcinoma and 43% end-stage liver disease. At enrolment, the median MELD score was 9 (range: 6-18); the Child-Pugh score was A in 65%, B in 35% and C in 2%. Therapy was discontinued because of severe adverse events (SAEs) in 39% of cases and virological inefficacy in 24%. 16% of patients had undetectable HCV RNA 24 weeks after the end of treatment (SVR24). LT was performed in 18 patients (35%). HCV RNA was undetectable in 16.6% at LT. Seven patients (14%) died and three deaths were attributed to treatment. SAEs (n=129) were observed in 84% of patients. Twenty-four percent of patients developed severe infections. Albumin<35g/L was independently associated with severe infection. Compared with baseline values, a significant decrease (P=0.02) of the physical dimension of health-related quality of life was observed between W4 and W24. The mean (95% CI) number of self-reported symptoms doubled during treatment (from 6.3 [4.8-7.7] to 11.8 [9.3-14.3]; P<0.001). CONCLUSIONS The safety of the PEG-IFN/RBV/boceprevir combination is poor in patients awaiting LT, with a high risk of severe infection. Moreover, the limited efficacy confirms the indication for IFN-free combinations in these patients.
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Affiliation(s)
- Hélène Fontaine
- Université Paris Descartes, Inserm USM20, Institut Pasteur, Assistance publique-Hôpitaux de Paris, service d'hépatologie, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - Marianne Maynard
- Department of hepatology, hôpital de la Croix-Rousse, hospices civils de Lyon, Lyon, France
| | - Cécile Bouix
- Department of hepatology, hôpital de la Croix-Rousse, hospices civils de Lyon, Lyon, France
| | - Maria Patrizia Carrieri
- Inserm, UMR912 (SESSTIM), Marseille, France; Aix Marseille université, UMR_S912, IRD, Marseille, France; Observatoire Régional de la Santé Provence-Alpes-Côte-d'Azur (ORS PACA), Marseille, France
| | | | - Louis D'Alteroche
- Department of Hepatology and Gastroenterology, Trousseau Hospital, Tours, France
| | - Filomena Conti
- Department of Hepatology, Saint-Antoine Hospital, Paris, France
| | - Georges-Philippe Pageaux
- Fédération médico-chirurgicale des maladies de l'appareil digestif, Saint-Eloi, Montpellier, France
| | - Vincent Leroy
- Department of Hepatology and Gastroenterology, La Tronche Hospital, Grenoble, France
| | - Sophie Métivier
- Department of Hepatology and Gastroenterology, Purpan Hospital, Toulouse, France
| | | | - François Durand
- Department of Hepatology, Beaujon Hospital, AP-HP, Clichy, France
| | - Valérie Canva
- Department of Hepatology and Gastroenterology, Claude-Huriez Hospital, Lille, France
| | - Antoine Vilotitch
- Inserm, UMR912 (SESSTIM), Marseille, France; Aix Marseille université, UMR_S912, IRD, Marseille, France; Observatoire Régional de la Santé Provence-Alpes-Côte-d'Azur (ORS PACA), Marseille, France
| | - Pascal Lebray
- Department of Hepatology and Gastroenterology, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Christophe Duvoux
- Hepatology and Gastroenterology, Henri-Mondor Hospital, Créteil, France
| | - Ventzislava Petrov-Sanchez
- Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord & sud Sida-HIV Hépatites [FRENSH]), Paris, France
| | - Frédérik Beaulieux
- Department of hepatology, hôpital de la Croix-Rousse, hospices civils de Lyon, Lyon, France
| | - Célia Wellems
- Department of hepatology, hôpital de la Croix-Rousse, hospices civils de Lyon, Lyon, France
| | - Christelle Paul
- Clinical Trial Safety Office, ANRS (France REcherche Nord & sud Sida-HIV Hépatites [FRENSH]), Paris, France
| | - Anne-Marie Roque-Afonso
- AP-HP, Hôpital Paul-Brousse, Centre Hépato-Biliaire, Inserm, Unit 1193, Université Paris-Sud, UMR-S1193, DHU Hepatinov, Villejuif, France
| | - Bruno Roche
- AP-HP, Hôpital Paul-Brousse, Centre Hépato-Biliaire, Inserm, Unit 1193, Université Paris-Sud, UMR-S1193, DHU Hepatinov, Villejuif, France
| | - Pierre Pradat
- Department of hepatology, hôpital de la Croix-Rousse, hospices civils de Lyon, Lyon, France
| | - Didier Samuel
- AP-HP, Hôpital Paul-Brousse, Centre Hépato-Biliaire, Inserm, Unit 1193, Université Paris-Sud, UMR-S1193, DHU Hepatinov, Villejuif, France
| | - Jean-Charles Duclos-Vallée
- AP-HP, Hôpital Paul-Brousse, Centre Hépato-Biliaire, Inserm, Unit 1193, Université Paris-Sud, UMR-S1193, DHU Hepatinov, Villejuif, France
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Bushyhead D, Goldberg D. Use of Hepatitis C-Positive Donor Livers in Liver Transplantation. ACTA ACUST UNITED AC 2017; 16:12-17. [PMID: 28243573 DOI: 10.1007/s11901-017-0327-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW The purpose of this article is to review recent literature regarding the use of Hepatitis C virus (HCV) positive donor livers in liver transplantation. Given the prevalence of HCV-positive patients on the waitlist coupled with high waitlist mortality, use of HCV-positive livers may be a means to meet patient needs. This review seeks to primarily answer the following questions: can HCV-positive livers be used safely and effectively? Are new direct acting antiviral medications safe and effective in HCV-positive liver recipients? RECENT FINDINGS Use of HCV-positive donor livers for liver transplantation in HCV-positive recipients is increasing. These donor livers have equivalent patient and graft survival when compared to HCV-negative donor livers in HCV-positive liver transplant recipients. Recent studies suggest that use of direct acting antiviral medications in HCV-positive liver transplant recipients can be successful, although there is insufficient data for their use in recipients of HCV-positive donor livers. SUMMARY HCV-positive donor livers may be safely and effectively used in HCV-positive liver transplant recipients. Direct acting antiviral medications appear safe and effective in HCV-positive liver transplant recipients, but data on their efficacy in HCV-positive liver transplant recipients are limited. Future research should focus on the use of HCV-positive donor livers in HCV-negative liver transplant recipients.
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Affiliation(s)
- Daniel Bushyhead
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David Goldberg
- Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.; Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Young J, Weis N, Hofer H, Irving W, Weiland O, Giostra E, Pascasio JM, Castells L, Prieto M, Postema R, Lefevre C, Evans D, Bucher HC, Calleja JL. The effectiveness of daclatasvir based therapy in European patients with chronic hepatitis C and advanced liver disease. BMC Infect Dis 2017; 17:45. [PMID: 28061762 PMCID: PMC5219681 DOI: 10.1186/s12879-016-2106-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 12/10/2016] [Indexed: 12/13/2022] Open
Abstract
Background There is limited evidence for the effectiveness of daclatasvir in patients whose hepatitis C threatens their life expectancy. The Named Patient Program in Europe included patients with advanced chronic hepatitis C, a life expectancy of less than 12 months and no other treatment options. Methods A retrospective multi-country cohort of patients with chronic hepatitis C who received daclatasvir as part of the Named Patient Program in Austria, Denmark, Spain, Sweden, Switzerland and the United Kingdom. Treatment response was defined as a sustained virologic response (unquantifiable hepatitis C RNA) at 12 weeks post treatment. We summarised the characteristics of the patients in this cohort and estimated the rate of sustained virologic response for patients receiving daclatasvir and sofosbuvir with or without ribavirin using hierarchical Bayesian modelling. Results The 249 patients included had a median age of 56 years; most were male (78%), hepatitis C genotype 1 (75%), treatment experienced (65%) and with decompensated cirrhosis (59%). Many had had a liver transplant before receiving daclatasvir (40%). Of the 249 patients, 242 patients received daclatasvir and sofosbuvir and either reached 12 weeks post treatment or died during (n = 9) or after treatment (n = 4) or were lost to follow up during treatment (n = 1). The estimated rate of sustained virologic response at 12 weeks post treatment was 87% (95% credible interval 75 to 94%) for previously treated genotype 1 patients with decompensated cirrhosis. Conclusions Daclatasvir with sofosbuvir is an effective treatment in clinical practice for hepatitis C genotype 1 patients with decompensated cirrhosis. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-2106-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jim Young
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 12, CH-4031, Basel, Switzerland.
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - Harald Hofer
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - William Irving
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, University of Nottingham, Nottingham, UK
| | - Ola Weiland
- Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Emiliano Giostra
- Service de Gastroentérologie et Hépatologie, Hôpitaux universitaires de Genève, Geneva, Switzerland
| | | | - Lluis Castells
- Liver Unit, Internal Medicine Department, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Martin Prieto
- Hepatology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Roelien Postema
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb, Uxbridge, United Kingdom
| | - Cinira Lefevre
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb, Rueil-Malmaison, France
| | - David Evans
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb, Rueil-Malmaison, France
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 12, CH-4031, Basel, Switzerland
| | - Jose Luis Calleja
- Liver Unit, Hospital Universitario Puerta de Hierro, Universidad Autonoma de Madrid, Madrid, Spain
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