A systematic review of direct acting antiviral therapies in hepatitis C virus‐negative liver transplant recipients of hepatitis C‐viremic donors. Issue 12 (25th November 2022) - Snyder, Heather S.
Abstract: The introduction of safe and highly effective direct acting antivirals (DAAs) has significantly improved hepatitis C virus (HCV) treatment outcomes after transplant. The solid organ transplant community has sought to identify strategies aimed at increasing the donor pool including the utilization of HCV‐viremic organs in HCV‐negative recipients. We will review the existing literature to evaluate DAA use for the treatment of HCV viremia post‐liver transplant in patients who receive HCV‐viremic allografts. A PubMed search was conducted and references for each study were also reviewed to identify additional articles. Randomized controlled trials, cohort studies, case series, and case reports were included if: published in English language, evaluated DAA treatment outcomes after liver only or simultaneous liver‐kidney transplantation with HCV‐viremic allografts in HCV‐negative recipients, and had full‐text article availability. Our review included 16 studies and 2 case reports. The majority of liver transplant recipients were treated with a pangenotypic DAA for 12 weeks with a heterogeneous median time to initiation (range 1.7–118 days). Sustained virologic response was assessed in 253 liver transplant patients with 99.6% achieving cure with minimal DAA‐attributed adverse drug events. There were 23 reported episodes of rejection, 12 deaths, and 1 graft loss among all studies. Treatment with DAA after transplantation of HCV‐viremic livers into HCV‐negative recipients appears to be safe and effective; however, long‐term outcomes remain unknown. Transplant pharmacists play a key role in the development of center‐specific protocols to optimize post‐transplant outcomes in this unique patient population.