🤑 HCV+ Hearts OK for Transplant With Preop DAAs | MedPage Today

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All 20 achieved SVR 12 weeks after treatment completion. All 20 recipients of NAT-positive hearts tolerated glecaprevir-pibrentasvir and showed rapid viral suppression, with a median time to clearance of 3. Comparing cardiac transplant wait times at the center over the past 4 years, Chung and colleagues found a significant reduction in time to transplant for patients willing to accept an organ from an HCV-positive donor. Patients were followed from enrollment to 1 year after transplantation. First, transplant recipients receive many medications and drug-drug interactions need to be prevented. No viremia developed in the five patients receiving NAT-negative hearts. Among study limitations, the authors noted its single-center setting and small sample size. In 20 recipients of HCV-positive hearts, glecaprevir-pibrentasvir Mavyret treatment resulted in a median time to viral clearance of 3. The open-label, proof-of-concept study recruited 55 patients from Massachusetts General Hospital Transplant Center over a month period ending in November Of these, 52 agreed to transplantation with a viremic donor heart, as determined by nucleic acid testing NAT. Samuel cited several caveats, however. Samuel reported personal fees from Gilead Sciences and AbbVie outside the submitted work.{/INSERTKEYS}{/PARAGRAPH} At present, health insurance coverage and reimbursements for donor-derived HCV infection are limited by the current environment, which allows payers to deny coverage, subject care providers to lengthy appeals processes, and place the burden of DAA cost on individual patients or transplant centers. Finally, HCV infection is rapid and requires pre-emptive DAA therapy to avoid liver disease, and since multiple viral strains are involved, the emergence of resistance is possible and regimens will require expert modification. In the wake of the opioid crisis, people who die from overdoses are now the fastest-growing organ donor group, and this population has a particularly high prevalence of HCV infection, they explained. In addition, recipients of HCV-positive organs must give informed consent, and rates of SVR seem to be equally high whether DAAs are started before or immediately after transplantation with 4 or 8 weeks of pre-emptive therapy. The authors noted that each year as many as hearts otherwise suitable for transplantation are estimated to be discarded in the U. Data analysis for the current publication reflects follow-up through May ; final study completion is planned for November Additionally, the absence of blinding and the comparison of outcomes in trial participants to those in historical controls made the results subject to selection and performance bias. According to Chung and associates, glecaprevir-pibrentasvir whose manufacturer did not fund the study might be better suited than other direct-acting antiviral agents DAAs for heart transplants since it avoids the potentially serious drug- interactions observed with sofosbuvir-based therapy. The pre-emptive oral glecaprevir-pibrentasvir regimen began before surgery and was followed by an 8-week course afterwards. {PARAGRAPH}{INSERTKEYS}Antiviral therapy for heart transplant patients begun prior to receiving organs from hepatitis C virus HCV infected donors resulted in timelier transplantation, rapid viral suppression, and excellent early allograft function, interim results of an open-label study showed. In addition, the superior early survival results shown in those patients undergoing HCV-positive heart transplantation might be partly attributable to the characteristics of overdose-death donors, including young age and few comorbidities. In comparison, historical controls waited a median days for transplants IQR , The authors warned, however, that while HCV-positive organ transplants could reduce time to transplantation and waitlist-associated mortality, they could also increase complications related to HCV allograft infection if timely access to effective treatment is not available. No patients required cessation of DAA therapy and no treatment- or HCV-related adverse event occurred during the study period. Second, the use of DAAs substantially increases transplantation costs. It might also better suit recipients of other organs from HCV-positive donors because it is pangenotypic, can be given pre-emptively, and can be used in patients with severely impaired kidney function. In addition, the short follow-up period precluded assessment of chronic rejection, coronary allograft vasculopathy, and long-term outcomes, including mortality, and further follow-up is required. Results were compared with historical controls who received HCV-negative hearts during the period of An additional 19 were transplanted with HCV-negative hearts.