Direct-Acting Antivirals: The Gold Standard for HCV Recurrence Following Transplantation?

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The majority of patients treated with second-generation direct-acting antiviral agents achieved sustained virologic response in 12 weeks.

According to one of the largest studies of its kind published in the American Journal of Transplantation, the use of second-generation direct-acting antivirals (DAAs) is highly effective in treating recurrent hepatitis C virus (HCV) infection in patients having undergone liver-kidney transplantation (LKT), including those who are difficult to treat.

The multicenter prospective ANRS C023 Compassionate Use of Protease Inhibitors in Viral C Liver Transplantation (CUPILT) study included 23 LKT patients with recurrent HCV who were treated with DAAs and followed for at least 12 weeks after treatment discontinuation. More than half of the study population had extensive fibrosis or cirrhosis on the graft (n=9) or fibrosing cholestatic hepatitis (n=3). All patients received at least 1 NS5B inhibitor (sofosbuvir) as part of their antiviral therapy regimen.

The primary end point of the study was met with 96% of patients achieving sustained virologic response at 12 weeks after treatment discontinuation. The antiviral therapy regimens were well tolerated; however, 9 patients (39.1%) experienced at least 1 serious adverse event. There were no deaths and no reports of transplant rejection throughout the study.

HCV recurrence is associated with reduced graft and patient survival following LKT and is also a cause of chronic kidney disease (CKD). The use of DAAs has demonstrated a high rate of HCV eradication in LKT patients regardless of the stage of fibrosis. The authors concluded that “DAAs regimens could become the gold standard for the treatment of recurrent HCV following LKT, allowing earlier treatment of patients before the development of graft fibrosis and CKD.”

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Dharancy S, Coilly A, Fougerou-Leurent C, et al. Direct acting antiviral agents-based regimen for HCV recurrence after combined liver-kidney transplantation: results from the ANRS CO23 CUPILT study [published online September 12, 2017]. Am J Transplant. doi:10.1111/ajt.14490