1
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Kaur N, Emamaullee J, Lian T, Lo M, Ender P, Kahn J, Sher L. Impact of Morbid Obesity on Liver Transplant Candidacy and Outcomes: National and Regional Trends. Transplantation 2021; 105:1052-1060. [PMID: 33741845 DOI: 10.1097/tp.0000000000003404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Body mass index (BMI) limits for liver transplant (LT) candidacy are controversial. In this study, we evaluate waitlist and post-LT outcomes, and prognostic factors and examine regional patterns of LT waitlist registration in patients with BMI ≥40 versus BMI 18-39. METHODS United Network for Organ Sharing (UNOS) data were analyzed to assess waitlist dropout, post-LT survival, and prognostic factors for patient survival. The distribution of waitlisted patients with BMI ≥40 was compared with the Centers for Disease Control Behavioral Risk Factors Surveillance System data to explore the rates of morbid obesity in the general population of each UNOS region. RESULTS Post-LT outcomes demonstrate a small but significantly lower 1- and 3-y overall survival for patients with BMI ≥45. Risk factors for post-LT mortality for patients with BMI ≥40 included age >60 y, prior surgery, and diabetes on multivariable analysis. Model for End-Stage Liver Disease >30 was significant on univariable analysis only, likely due to the limited number of patients with BMI ≥40; however, median Model for End-Stage Liver Disease scores in this BMI group were higher than those in patients with lower BMI across all UNOS regions. Patients with BMI ≥40 had a higher waitlist dropout in 4 regions. Comparison with BRFSS data illustrated that the proportion of waitlisted patients with BMI ≥40 was significantly lower than the observed rates of morbid obesity in the general population in 3 regions. CONCLUSIONS While BMI ≥45 is associated with modestly lower patient survival, careful selection may equalize these numbers.
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Affiliation(s)
- Navpreet Kaur
- Department of Surgery, University of Southern California, Los Angeles, CA
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Juliet Emamaullee
- Department of Surgery, University of Southern California, Los Angeles, CA
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Tiffany Lian
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Mary Lo
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Philip Ender
- Statistical Consulting Group, University of California-Los Angeles, Los Angeles, CA
| | - Jeffrey Kahn
- Keck School of Medicine, University of Southern California, Los Angeles, CA
- Department of Medicine, University of Southern California, Los Angeles, CA
| | - Linda Sher
- Department of Surgery, University of Southern California, Los Angeles, CA
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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2
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Liu J, Ma B, Cao W, Li M, Bramer WM, Peppelenbosch MP, Pan Q. Direct-acting antiviral agents for liver transplant recipients with recurrent genotype 1 hepatitis C virus infection: Systematic review and meta-analysis. Transpl Infect Dis 2019; 21:e13047. [PMID: 30615227 PMCID: PMC6850617 DOI: 10.1111/tid.13047] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/18/2018] [Accepted: 12/23/2018] [Indexed: 12/15/2022]
Abstract
Background Comprehensive evaluation of safety and efficacy of different combinations of direct‐acting antivirals (DAAs) in liver transplant recipients with genotype 1 (GT1) hepatitis C virus (HCV) recurrence remains limited. Therefore, we performed this systematic review and meta‐analysis in order to evaluate the clinical outcome of DAA treatment in liver transplant patients with HCV GT1 recurrence. Methods Studies were included if they contained information of 12 weeks sustained virologic response (SVR12) after DAA treatment completion as well as treatment related complications for liver transplant recipients with GT1 HCV recurrence. Results We identified 16 studies comprising 885 patients. The overall pooled estimate proportion of SVR12 was 93% (95% confidence interval (CI): 0.89, 0.96), with moderate heterogeneity observed (τ2 = 0.01, P < 0.01, I2=75%). High tolerability was observed in liver transplant recipients reflected by serious adverse events (sAEs) with pooled estimate proportion of 4% (95% CI: 0.01, 0.07; τ2 = 0.02, P < 0.01, I2 = 81%). For subgroup analysis, a total of five different DAA regimens were applied for treating these patients. Sofosbuvir/Ledipasvir (SOF/LDV) led the highest pooled estimate SVR12 proportion, followed by Paritaprevir/Ritonavir/Ombitasivir/Dasabuvir (PrOD), Daclatasvir (DCV)/Simeprevir (SMV) ± Ribavirin (RBV), and SOF/SMV ± RBV, Asunaprevir (ASV)/DCV. There was a tendency for favoring a higher pooled SVR12 proportion in patients with METAVIR Stage F0‐F2 of 97% (95% CI: 0.93, 0.99) compared to 85% (95% CI: 0.79, 0.90) for stage F3‐F4 (P < 0.01). There was no significant difference between LT recipients treated with or without RBV (P = 0.23). Conclusions Direct‐acting antiviral treatment is highly effective and well‐tolerated in liver transplant recipients with recurrent GT1 HCV infection.
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Affiliation(s)
- Jiaye Liu
- Biomedical Research Center, Northwest Minzu University, Lanzhou, China.,Erasmus MC Cancer Institute, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Buyun Ma
- Erasmus MC Cancer Institute, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Wanlu Cao
- Erasmus MC Cancer Institute, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Meng Li
- Erasmus MC Cancer Institute, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Wichor M Bramer
- Department of Medical Library, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Maikel P Peppelenbosch
- Erasmus MC Cancer Institute, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Qiuwei Pan
- Biomedical Research Center, Northwest Minzu University, Lanzhou, China.,Erasmus MC Cancer Institute, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
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3
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Yosry A, Gamal Eldeen H, Medhat E, Mehrez M, Zayed N, Elakel W, Abdelmoniem R, Kaddah M, Abdelaziz A, Esmat G, El-Serafy M, Doss W. Efficacy and safety of sofosbuvir-based therapy in hepatitis C virus recurrence post living donor liver transplant: A real life egyptian experience. J Med Virol 2018; 91:668-676. [PMID: 30549048 DOI: 10.1002/jmv.25362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 11/13/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND AIM Direct acting antiviral has offered treatment of hepatitis C virus (HCV) recurrence post liver transplantation (LT) with an all-oral regimen for short duration, excellent safety profile, and high sustained virological response (SVR). The aim of this study was to evaluate the efficacy and safety of sofosbuvir (SOF)-based regimens in the real world among a cohort of Egyptian patients with recurrent HCV post living donor LT (LDLT). METHODS Patients with HCV-G4 recurrence post-LDLT were recruited from National Committee of Control of Viral Hepatitis, Egypt, from November 2014 to May 2017. They received different SOF-based regimens according to the treatment protocols available during this period. Patients' outcome and Adverse effects (AE) were evaluated. RESULTS One hundred ninety patients (170 males, mean age 56.8 ± 7.9 years) were included. Calcineurin inhibitors were the main immunosuppression used (173 patients). Out of 190, 119 (62.6%) received SOF/ribavirin (RBV), 38 (20%) SOF/simeprevir (SMV), 22 (11.6%) SOF/daclatasvir (DSV)/ ± RBV, and 11 (5.8%) received SOF/LDV/ ± RBV. Overall SVR12 was 89.5%, 84.9% in SOF/RBV group, 94.7% in SOF/SMV, 100% in SOF/DCV, and 100% in SOF/LDV with no statistically significant difference ( P = 0.104). The AE reported were as follows: anemia (n = 65, 34.4%) mainly in SOF/RBV group, transient hyperbilirubinemia during SOF/SMV in 13 patients (34%), mild Acute cellular rejection in eight patients (4.2%), and hepatocellular carcinoma in two patients (1%) mainly driven by underlying liver condition. Two deaths were unlikely related to HCV therapy. CONCLUSION Different SOF-based regimens were effective with high SVR12 rates in a difficult-to-treat population, recurrent HCV post LDLT.
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Affiliation(s)
- Ayman Yosry
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hadeel Gamal Eldeen
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eman Medhat
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mai Mehrez
- National Hepatology and Tropical Medicine Research Institute, Cairo Governorate, Egypt
| | - Naglaa Zayed
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Wafaa Elakel
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Reham Abdelmoniem
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mona Kaddah
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ashraf Abdelaziz
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Gamal Esmat
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Magdy El-Serafy
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Wahid Doss
- Department of Endemic Medicine and Hepatology, Faculty of Medicine, Cairo University, Cairo, Egypt
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4
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Jain A, Riley TR, Krok KL, Schreibman I, Karamchandani DM, Liao X, Tian Y, Dohi T, Kadry Z. Incidence of Post-Liver Transplant Hepatic Dysfunction After Sustained Virologic Response Following Direct-Acting Anti-Hepatitis C Therapy. EXP CLIN TRANSPLANT 2018; 18:345-352. [PMID: 30295586 DOI: 10.6002/ect.2018.0127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Newly developed, direct-acting antiviral therapy is effective in over 90% of cases to eradicate hepatitis C virus infection. Direct-acting antiviral therapy is also effective in liver transplant recipients with recurrent hepatitis C virus infection. However, hepatic function after sustained virologic response in transplant recipients is unknown. Here, we aimed to uncover the incidence of hepatic dysfunction in this patient group at our center. MATERIALS AND METHODS Our study included 40 consecutive (January 2014 to February 2016) and compliant posttransplant recipients who achieved sustained viral response from direct-acting antiviral therapy. Patients were investigated for incidence and causes of hepatic dysfunction. RESULTS In our patient group, 4 (10%) experienced hepatic dysfunction with stable baseline immunosuppression, with 2 having drastic increases in alanine aminotransferase at 15 and 32 weeks after direct-acting antiviral therapy. Biopsies showed hepatitis, and both patients were treated with hydrocortisone, which increased their baseline immunosuppression. The 3rd patient had an increase in bilirubin at 21 weeks posttherapy, with biopsy showing macrovascular steatosis. The 4th patient had a rapid increase in bilirubin at 7 weeks after direct-acting antiviral therapy, with biopsy showing significant duct loss. CONCLUSIONS During the study period, 10% of patients experienced hepatic dysfunction after sustained viral response. Presumed causative factors included partial immune reconstitution and nonalcoholic fatty liver disease.
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Affiliation(s)
- Ashokkumar Jain
- From the Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
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5
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Saab S, Challita Y, Chen PH, Jimenez MA, Lee AD, Saab EG, Ahn T, Choi G, Durazo FA, El-Kabany MM, Han SHB, Grotts J, Agopian VG, Busuttil RW. Elimination of Hepatitis C in Liver Transplant Recipients. J Clin Transl Hepatol 2018; 6:247-250. [PMID: 30271735 PMCID: PMC6160303 DOI: 10.14218/jcth.2017.00079] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/20/2018] [Accepted: 02/26/2018] [Indexed: 12/11/2022] Open
Abstract
Background and Aims: Recurrent hepatitis C (HCV) disease in liver transplant (LT) recipients is associated with significant morbidity and mortality. With the availability of noninterferon-based therapy, eliminating HCV may be achievable in LT recipients. Methods: We studied all consecutive recipients who underwent LT at the University of California Los Angeles between January 2005 and June 2017. We collected data on date of transplant and last follow-up, as well as laboratory values. We also recorded type and timing of antiviral therapy relative to LT. Analyses were performed to assess the proportion of LT recipients who are viremic after transplant. Results: Six hundred thirty-four patients underwent LT with a diagnosis of HCV. There was a statistically significant trend for patients to be cured before (p < 0.001) and after liver transplantation (p < 0.001) for the study period of 2014 to 2016 relative to 2005 and 2013, respectively. Of the 634 recipients eligible for therapy, 8% and 74% were treated within 12 months of transplant for the study periods 2005 to 2013 and 2014 to 2016, respectively. There was a significant decrease between the two study periods in the proportion of patients undergoing re-LT 1 year after the original LT: 5.5% (n = 28/510) and 1.5% (n = 2/124) respectively for study periods 2005 to 2013 and 2014 to 2016 respectively (p = 0.011). Conclusions: The proportion of LT recipients who are viremic has decreased over time. Eliminating HCV in LT recipients is feasible after the introduction of direct-acting agents. Curing HCV should translate to improved clinical outcomes in LT recipients who were transplanted for HCV infection with longer follow-up. Preliminary results suggest the decreased need for transplant in the direct-acting agents era.
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Affiliation(s)
- Sammy Saab
- Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA
- Department of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
- *Correspondence to: Sammy Saab, Pfleger Liver Institute, UCLA Medical Center, 200 Medical Plaza, Suite 214, Los Angeles, CA 90095, USA. Tel: +1-310-206-6705, Fax: +1-310-206-4197, E-mail:
| | - Youssef Challita
- Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Phillip H. Chen
- Department of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Melissa A. Jimenez
- Department of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Alex D. Lee
- Department of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Elena G. Saab
- Department of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Timothy Ahn
- Department of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Gina Choi
- Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA
- Department of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Francisco A. Durazo
- Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA
- Department of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Mohamed M. El-Kabany
- Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA
- Department of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Steven-Huy B. Han
- Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA
- Department of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Jonathan Grotts
- Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Vatche G. Agopian
- Department of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Ronald W. Busuttil
- Department of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
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6
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Vukotic R, Conti F, Fagiuoli S, Morelli MC, Pasulo L, Colpani M, Foschi FG, Berardi S, Pianta P, Mangano M, Donato MF, Malinverno F, Monico S, Tamè M, Mazzella G, Belli LS, Viganò R, Carrai P, Burra P, Russo FP, Lenci I, Toniutto P, Merli M, Loiacono L, Iemmolo R, Degli Antoni AM, Romano A, Picciotto A, Rendina M, Andreone P. Long-term outcomes of direct acting antivirals in post-transplant advanced hepatitis C virus recurrence and fibrosing cholestatic hepatitis. J Viral Hepat 2017; 24:858-864. [PMID: 28370880 DOI: 10.1111/jvh.12712] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/22/2017] [Indexed: 12/14/2022]
Abstract
Long-term functional outcomes of sofosbuvir-based antiviral treatment were evaluated in a cohort study involving 16 Italian centres within the international compassionate use programme for post-transplant hepatitis C virus (HCV) recurrence. Seventy-three patients with cirrhosis (n=52) or fibrosing cholestatic hepatitis (FCH, n=21) received 24-week sofosbuvir with ribavirin±pegylated interferon or interferon-free sofosbuvir-based regimen with daclatasvir/simeprevir+ribavirin. The patients were observed for a median time of 103 (82-112) weeks. Twelve of 73 (16.4%) died (10 non-FCH, 2 FCH) and two underwent re-LT. Sustained virological response was achieved in 46 of 66 (69.7%): 31 of 47 (66%) non-FCH and 15 of 19 (79%) FCH patients. All relapsers were successfully retreated. Comparing the data of baseline with last follow-up, MELD and Child-Turcotte-Pugh scores improved both in non-FCH (15.3±6.5 vs 10.5±3.8, P<.0001 and 8.4±2.1 vs 5.7±1.3, P<.0001, respectively) and FCH (17.3±5.9 vs 10.1±2.8, P=.001 and 8.2±1.6 vs 5.5±1, P=.001, respectively). Short-treatment mortality was higher in patients with baseline MELD≥25 than in those with MELD<25 (42.9% vs 4.8%, P=.011). Long-term mortality was 53.3% among patients with baseline MELD≥20 and 7.5% among those with MELD<20 (P<.0001). Among deceased patients 75% were Child-Turcotte-Pugh class C at baseline, while among survivors 83.9% were class A or B (P<.0001). Direct acting antivirals-based treatments for severe post-transplant hepatitis C recurrence, comprising fibrosing cholestatic hepatitis, significantly improve liver function, even without viral clearance and permit an excellent long-term survival. The setting of severe HCV recurrence may require the identification of "too-sick-to-treat patients" to avoid futile treatments.
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Affiliation(s)
- R Vukotic
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - F Conti
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - S Fagiuoli
- Dipartimento di Medicina Specialistica e dei Trapianti, U.S.C. Gastroenterologia Epatologia e Trapiantologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - M C Morelli
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - L Pasulo
- Dipartimento di Medicina Specialistica e dei Trapianti, U.S.C. Gastroenterologia Epatologia e Trapiantologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - M Colpani
- Dipartimento di Medicina Specialistica e dei Trapianti, U.S.C. Gastroenterologia Epatologia e Trapiantologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - F G Foschi
- AUSL della Romagna, Presidio Ospedaliero di Faenza, Faenza, Italy
| | - S Berardi
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - P Pianta
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - M Mangano
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - M F Donato
- Gastroenterologia ed Epatologia, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico ed Univerisità di Milano, Milan, Italy
| | - F Malinverno
- Gastroenterologia ed Epatologia, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico ed Univerisità di Milano, Milan, Italy
| | - S Monico
- Gastroenterologia ed Epatologia, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico ed Univerisità di Milano, Milan, Italy
| | - M Tamè
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - G Mazzella
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
| | - L S Belli
- Dipartimento di Epatologia e Gastroenterologia, Ospedale Niguarda, Milan, Italy
| | - R Viganò
- Dipartimento di Epatologia e Gastroenterologia, Ospedale Niguarda, Milan, Italy
| | - P Carrai
- Chirurgia biliopancreatica e Trapianto di Fegato, Università di Pisa, Pisa, Italy
| | - P Burra
- Dipartimento di Chirurgia, Oncologia e Gastroenterologia, Unità di Trapianto Multiviscerale, Ospedale Universitario Padova, Padua, Italy
| | - F P Russo
- Dipartimento di Chirurgia, Oncologia e Gastroenterologia, Unità di Trapianto Multiviscerale, Ospedale Universitario Padova, Padua, Italy
| | - I Lenci
- Unità di Epatologia, Università Tor Vergata, Rome, Italy
| | - P Toniutto
- Medicina Interna Sezione di Trapianto di Fegato, Università di Udine, Udine, Italy
| | - M Merli
- Dipartimento di Medicina Clinica La Sapienza, Gastroenterologia, Università di Roma, Rome, Italy
| | | | - R Iemmolo
- Chirurgia Oncologica Epato-bilio-pancreatica e Chirurgia dei Trapianti di fegato, AOU di Modena, Modena, Italy
| | - A M Degli Antoni
- Unità di Malattie Infettive ed Epatologia, AOU di Parma, Parma, Italy
| | - A Romano
- Dipartimento di Medicina, Unità delle Emergenze epatologiche e dei Trapianti di fegato, Università di Padova, Padua, Italy
| | - A Picciotto
- Dipartimento di Medicina Interna, Università degli Studi di Genova, Genova, Italy
| | - M Rendina
- Unità Operativa Gastroenterologia ed Endoscopia Digestiva, Policlinico Universitario di Bari, Bari, Italy
| | - P Andreone
- Centro di Ricerca per lo Studio delle Epatiti, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Bologna, Italy
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7
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Russo FP, Zanetto A, Burra P. Timing for treatment of HCV recurrence after liver transplantation: the earlier the better. Transpl Int 2017; 29:694-7. [PMID: 26713429 DOI: 10.1111/tri.12739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 12/18/2015] [Indexed: 12/18/2022]
Affiliation(s)
| | - Alberto Zanetto
- Multivisceral Transplant Unit, Padua University Hospital, Padua, Italy
| | - Patrizia Burra
- Multivisceral Transplant Unit, Padua University Hospital, Padua, Italy
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8
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Sofosbuvir/Ledipasvir Without Ribavirin Achieved High Sustained Virologic Response for Hepatitis C Recurrence After Liver Transplantation: Two-Center Experience. Transplantation 2017; 101:996-1000. [PMID: 27631598 DOI: 10.1097/tp.0000000000001467] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Current recommended regimens to treat patients with hepatitis C virus (HCV) infection after liver transplantation include the use of ribavirin (RBV). Limited data are available on the efficacy of RBV-free regimens posttransplant, particularly the use of sofosbuvir (SOF)/ledipasvir (LDV) without RBV in this patient population. We aimed to assess the efficacy and safety of SOF/LDV fixed-dose combination without RBV in patients with HCV recurrence posttransplant. METHODS This is a retrospective study of 46 patients with HCV recurrence posttransplant. SOF/LDV without RBV was used for 12 weeks in patients with early-stage fibrosis (F0-F2) or for 24 weeks in those with advanced fibrosis (F3-F4) and/or cholestatic hepatitis. The primary endpoint was sustained virologic response at 12 weeks after the end of treatment. Secondary outcomes included relapse after treatment and adverse events. RESULTS Forty-six patients, with a mean age of 62 ± 8 years, a median duration since time of transplant of 904 days (range, 78-3525 days), an HCV genotype 1, and a mean baseline viral load of 7.79 million IU/mL, were treated. Of these, 32 patients were treated for 12 weeks, and 14 patients were treated for 24 weeks. Twenty-five patients (54%) were treatment experienced (21 with interferon and 4 with SOF). All 46 patients (100%) achieved sustained virological response (SVR) 12. Neither virologic relapses nor serious adverse events were noted. CONCLUSIONS The combination of SOF/LDV without RBV for 12 or 24 weeks produced 100% SVR 12 in patients with HCV recurrence after liver transplantation. The use of RBV may not be necessary to achieve SVR in this patient population.
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9
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Fernández Carrillo C, Crespo G, de la Revilla J, Castells L, Buti M, Montero JL, Fábrega E, Fernández I, Serrano-Millán C, Hernández V, Calleja JL, Londoño MC. Successful Continuation of HCV Treatment After Liver Transplantation. Transplantation 2017; 101:1009-1012. [PMID: 27906834 DOI: 10.1097/tp.0000000000001596] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Guidelines recommend that patients with hepatitis C virus (HCV)-related liver disease be treated for HCV before liver transplant (LT) to eliminate the virus before surgery. However, the unpredictability of donor organ availability may limit treatment duration. Interruption of HCV treatment with resumption post-LT is 1 potential solution which has not been investigated widely. METHODS Patients from 5 clinical centers included in the large, national, noninterventional Hepa-C registry who started treatment with direct-acting antiviral agents while awaiting LT were identified retrospectively and followed up prospectively. Fifteen patients who had treatment interruptions around LT were identified. RESULTS The majority of patients (12/15) received interferon-free regimens, most commonly sofosbuvir + daclatasvir (8/12), for a total of 24 weeks (13/15). Treatment was discontinued temporarily for a median of 5 (range, 2-33) days. Fourteen patients completing 12 weeks of follow-up achieved a sustained virological response. One patient who died before week 12 posttreatment achieved a response at posttreatment week 4. Treatment was generally well tolerated. Serious adverse events were recorded in 2 of 15 patients (anaemia in 1 patient; pneumonia in 1 patient); all arose after LT. CONCLUSIONS Resumption of direct-acting antiviral agent therapy after a temporary interruption around LT was highly effective, achieving sustained virological response in all patients who completed 12 weeks of posttreatment follow-up. Treatment was generally well tolerated pretransplantation and posttransplantation, with a low rate of serious adverse events. Such a strategy may offer an important new approach to the treatment of patients awaiting LT which may be assessed in future studies.
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Affiliation(s)
- Carlos Fernández Carrillo
- 1 Liver Unit, Hospital Universitario Puerta de Hierro-Majadahonda, IDIPHIM, CIBERehd, Majadahonda, Madrid, Spain. 2 Liver Unit, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain. 3 Liver Unit, Internal Medicine Department, Hospital Universitario Vall d'Hebron, CIBERehd, Barcelona, Spain. 4 Hepatology and Liver Transplant Unit, Hospital Universitario Reina Sofía, IMIBIC, CIBERehd, Córdoba, Spain. 5 Gastroenterology and Hepatology Unit, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain. 6 Digestive Service, Hospital Universitario 12 de Octubre, Madrid, Spain. 7 Liver Unit, Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid and CIBERehd, Madrid, Spain
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10
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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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11
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Chen K, Lu P, Song R, Zhang J, Tao R, Wang Z, Zhang W, Gu M. Direct-acting antiviral agent efficacy and safety in renal transplant recipients with chronic hepatitis C virus infection: A PRISMA-compliant study. Medicine (Baltimore) 2017; 96:e7568. [PMID: 28746204 PMCID: PMC5627830 DOI: 10.1097/md.0000000000007568] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The efficacy and safety of direct-acting antivirals (DAAs) for treating hepatitis C virus (HCV)-infected renal transplant recipients (RTRs) has not been determined. METHODS We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials and assessed the quality of eligible studies using the Joanna Briggs Institute scale. DAA efficacy and safety were assessed using standard mean difference (SMD) with 95% confidence intervals (95%CIs). RESULTS Six studies (360 RTRs) were included. Two hundred thirty six RTRs (98.3%) achieved sustained virological response within 12 weeks; HCV infection was cleared in 239 RTRs after 24-week treatment. Liver function differed significantly pre- and posttreatment (alanine aminotransferase, SMD: 0.96, 95%CIs: 0.65, 1.26; aspartate aminotransferase, SMD: 0.89, 95%CIs: 0.60, 1.18); allograft function pre- and posttreatment was not statistically different (serum creatinine, SMD: -0.13, 95%CIs: -0.38, 0.12; estimated glomerular filtration rate, SMD: 0.20, 95%CIs: -0.11, 0.51). General symptoms (fatigue nausea dizziness or headache) were the most common adverse events (AEs) (39.3%). Severe AEs, that is, anemia, portal vein thrombosis, and streptococcus bacteraemia and pneumonia, were present in 1.1%, 0.6%, and 1.1% of RTRs, respectively. CONCLUSION Our findings suggest that DAAs are highly efficacious and safe for treating HCV-infected RTRs and without significant AE.
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12
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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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13
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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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14
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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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Sanchez Antolin G, Testillano M, Pascasio JM, Narvaez Rodriguez I, Prieto M, Otero A, Herrero JI, Londoño M, Fernandez Vazquez I, Castells L. Efficacy and Safety of Therapy With Simeprevir and Sofosbuvir in Liver Transplant Recipients Infected by Hepatitis C Virus Genotype 4: Cohort Spanish Society of Liver Transplantation Cohort. Transplant Proc 2017; 48:3013-3016. [PMID: 27932134 DOI: 10.1016/j.transproceed.2016.08.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 08/22/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with hepatitis C virus (HCV) genotype 4 infection are poorly represented in clinical trials of 2nd-generation direct-acting antivirals (DAAs), and more data are needed to help guide treatment decisions. We still have even fewer data concerning liver transplant patients. Simeprevir (SIM) and sofosbuvir (SOF) combination is useful to treat this genotype. The aim of this study was to know the efficacy and safety of the combination SIM + SOF ± ribavirin (RBV) in a group of liver transplant patients with HCV genotype 4 infection in Spain in real life. METHODS This was a multicenter retrospective study, including 28 HCV genotype 4 patients from 11 liver transplant centers who were treated with SIM + SOF ± RBV. We included in the analysis demographic, clinical, and virologic data and details of serious adverse events (SAEs), including mortality rate 6 months after treatment. RESULTS All patients were male, mean age 52 ± 9.43 years, and 50% were IL28B CT and 37.5% TT; 46.42% of them were pretreated and 76.9 were null responders. Fibrosis stage 4 was found in 38.7% of patients; in 67.8% of those cases the diagnosis of fibrosis was made with the use of Fibroscan, in 21.4% by liver biopsy. The average Fibroscan was 13.86 KPa. The average Model for End-Stage Liver Disease (MELD) score of cirrhotic patients was 10.9 and the Child-Pugh score was A in 70%, B in 20%, and C in 10%. We included RBV in 75% of patients, and treatment duration was 12 weeks in all patients. The sustained virologic response at week 12 (SVR12) was 95.23%. There were no discontinuations due to SAEs, but the mortality rate at 6 months after treatment was 7.14%. All deceased patients were cirrhotic, Child C, and with an average MELD score of 20. CONCLUSIONS The combination SIM + SOF ± RBV to treat HCV genotype 4 in liver transplant patients is an option with high rates of SVR12 and very safe, similarly to genotype 1. There was no treatment-related mortality, but when it is administered in advanced stages of fibrosis it may not be enough to prevent mortality associated with cirrhotic hepatitis C recurrence after transplantation.
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Affiliation(s)
- G Sanchez Antolin
- Hepatology Unit, Liver Transplant Unit, Hospital Universitario Rio Hortega, Valladolid, Spain.
| | - M Testillano
- Hepatology Unit, Liver Transplant Unit, Hospital Universitario Cruces, Bilbao, Spain
| | - J M Pascasio
- Hepatology Unit, Hospital Universitario Virgen del Rocio, CIBERhed, Sevilla, Spain
| | - I Narvaez Rodriguez
- Gastroenterology Service, Liver Transplant Unit Hospital Infanta Cristina, Badajoz, Spain
| | - M Prieto
- Hepatology Unit, Hospital, Liver Transplant Unit Universitario La Fe, Valencia, Spain
| | - A Otero
- Liver Transplant Unit, Hospital Universitario Juan Canalejo, La Coruña, Spain
| | - J I Herrero
- Service of Internal Medicine, Liver Transplant Unit, CUN, Pamplona, Spain
| | - M Londoño
- Hepatology Service, Liver Transplant Unit, Hospital Clinic, CIBERhed, Barcelona, Spain
| | - I Fernandez Vazquez
- Service of Gastroenterology, Hepatology Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - L Castells
- Service of Hepatology, CIBERhed Hospital Universitario, Vall d'Hebrón, Spain
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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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Anand AC. Potential Liver Transplant Recipients with Hepatitis C: Should They Be Treated Before or After Transplantation? J Clin Exp Hepatol 2017; 7:42-54. [PMID: 28348470 PMCID: PMC5357718 DOI: 10.1016/j.jceh.2017.01.116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 01/31/2017] [Indexed: 12/12/2022] Open
Abstract
Treatment of hepatitis C virus (HCV) with newer directly acting antivirals (DAAs) and lead to sustained viral response (SVR) in majority of patients and SVR has been documented to be associated with reversal of liver cirrhosis. The improved SVR rates and safety profiles of DAAs have led to the treatment of patients with decompensated cirrhosis awaiting liver transplantation (LT). Several clinical trials of DAAs in decompensated HCV patients have recently demonstrated SVR rates above 80%, which have been associated with significant improvements, in the Child-Pugh-Turcotte scores/or model for end-stage liver disease scores in a proportion of patients. Moreover, it has been shown that HCV RNA becomes negative after 2-4 weeks of treatment, and those who are transplanted after becoming HCV RNA negative will be have very low the risk of HCV recurrence after transplantation. Some of the patients may have reached the "point of no return" and may proceed to worsening of decomposition over time. To avoid the risk of worsening, there is an additional option of treating these patients after LT should they develop recurrent HCV infection. Currently there are no guidelines as to select patients who would benefit from treatment prior to LT as opposed to those who will be better off being treated after the transplant surgery. The article discusses a possible approach for such selection.
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Key Words
- CSA, cyclosporine A
- CTP, Child–Turcotte–Pugh staging
- DAA, directly acting antivirals
- DCV, daclatasvir
- DDLT, deceased donor liver transplant
- DSB, dasabuvir
- EBV, elbasvir
- FCH, fibrosing cholestatic hepatitis
- GRZ, grazoprevir
- GT, genotype
- HCV, hepatitis C virus
- IU, international units
- LDLT, living donor liver transplant
- LDV, ledipasvir
- LT, liver transplantation
- MELD, model for end-stage liver disease RNA
- OMB, ombitasvir
- PTV, paritaprevir
- Peg-IFN, pegylated interferon alfa
- RBV, ribavirin
- SMV, simeprevir
- SOF, sofosbuvir
- SVR, sustained virological response, (SVR 12 signifies SVR at 12 weeks)
- TAC, tacrolimus
- VLP, velpatasvir
- decompensated cirrhosis
- directly acting antivirals
- hepatitis C virus infection
- liver transplantation
- rt, ritonavir
- sustained virological response
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Affiliation(s)
- Anil C. Anand
- Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, India
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18
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Use of Sofosbuvir-Based Treatment of Chronic Hepatitis C in Liver Transplant Recipients on Hemodialysis. J Clin Gastroenterol 2017; 51:167-173. [PMID: 27548734 DOI: 10.1097/mcg.0000000000000640] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The use of direct acting agents has changed the management paradigm of hepatitis C (HCV) in liver transplant (LT) recipients. However, the appropriate antiviral regimen in LT recipients on hemodialysis (HD) remains unclear. METHODS We retrospectively evaluated the safety and efficacy of sofosbuvir-based LT recipients on HD followed at the University of California Los Angeles. RESULTS Twelve LT recipients on HD were treated for recurrent HCV with sofosbuvir-based therapy. Indications for antiviral therapy included fibrosing cholestatic hepatitis, symptomatic cryoglobulinemia, and recurrent HCV. The causes of renal failure included hepatorenal syndrome, acute tubular necrosis and cryoglobulinemia. Of those who were not on dialysis at the time of transplantation, the mean creatinine (±SD) was 1.7 (±0.8) mg/dL. The mean age (±SD) of the cohort was 62.2 (±6.0) years. Most recipients were male (67%) and infected with genotype 1 (83%). Baseline alanine aminotransferase, total bilirubin, hemoglobin and HCV RNA values (±SD) were 53.2 (±59.4) IU/L, 3.2 (±5.5) mg/dL, 10.5 (±1.8) g/dL, and 30,499,500 (±29,655,754) IU/mL. HCV RNA levels were undetectable in all recipients at the end of therapy. The trough mean (±SD) hemoglobin of patients on treatment and on HD was 8.4 (±2.3). The sustained viral response was 58% (7/12), and the overall patient survival was 42%. All the deaths occurred a mean (±SD) after 5.4 (±3.6) months after treatment was completed. CONCLUSIONS All patients achieved viral suppression from therapy, and over half the recipients achieved a sustained virological response. A high mortality underscores the necessity of starting antiviral treatment sooner in LT recipients and the need for larger cohort studies.
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O'Leary JG, Fontana RJ, Brown K, Burton JR, Firpi-Morell R, Muir A, O'Brien C, Rabinovitz M, Reddy R, Ryan R, Shprecher A, Villadiego S, Prabhakar A, Brown RS. Efficacy and safety of simeprevir and sofosbuvir with and without ribavirin in subjects with recurrent genotype 1 hepatitis C postorthotopic liver transplant: the randomized GALAXY study. Transpl Int 2017; 30:196-208. [PMID: 27896858 DOI: 10.1111/tri.12896] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/05/2016] [Accepted: 11/25/2016] [Indexed: 12/14/2022]
Abstract
This prospective, randomized, phase 2 study in subjects with recurrent hepatitis C virus (HCV) genotype 1 postorthotopic liver transplant evaluated once-daily simeprevir 150 mg + sofosbuvir 400 mg, with and without ribavirin 1000 mg. Primary endpoint was proportion of subjects with week 12 sustained virologic response (SVR12). Thirty-three subjects without cirrhosis were randomized 1:1:1 into three arms (stratified by genotype/subtype and Q80K): Arm 1, simeprevir + sofosbuvir + ribavirin, 12 weeks; Arm 2, simeprevir + sofosbuvir, 12 weeks; Arm 3, simeprevir + sofosbuvir, 24 weeks; 13 additional subjects (two with cirrhosis, 11 without cirrhosis) entered Arm 3. All 46 subjects received at least one dose of study drug; median age, 60 years; 73.9% male; 80.4% White; 71.7% genotype/subtype 1a [12 (36.4%) of these had Q80K]; median 4.5 years post-transplant. Among randomized subjects, SVR12 was achieved by 81.8% in Arm 1, 100% in Arm 2, and 93.9% in Arm 3; two subjects did not achieve SVR12: one viral relapse (follow-up week 4; Arm 1) and one missing follow-up week 12 data. In total, five subjects had a serious adverse event, considered unrelated to treatment per investigator. Simeprevir exposure was increased relative to the nontransplant setting, but not considered clinically relevant. Simeprevir + sofosbuvir treatment, with or without ribavirin, was efficacious and well tolerated (ClinicalTrials.gov Identifier: NCT02165189).
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Affiliation(s)
| | - Robert J Fontana
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kimberly Brown
- Department of Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - James R Burton
- Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | | | - Andrew Muir
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Christopher O'Brien
- Department of Medicine, University of Miami School of Medicine, Miami, FL, USA
| | | | - Rajender Reddy
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Ryan
- Janssen Research & Development, Titusville, NJ, USA
| | | | | | | | - Robert S Brown
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
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20
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Shoreibah M, Orr J, Jones D, Zhang J, Venkata K, Massoud O. Ledipasvir/sofosbuvir without ribavirin is effective in the treatment of recurrent hepatitis C virus infection post-liver transplant. Hepatol Int 2017; 11:434-439. [PMID: 28083718 DOI: 10.1007/s12072-016-9778-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/09/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND/AIM Recurrent hepatitis C virus infection is a challenging complication post-liver transplant. Current guidelines recommend the combination of ribavirin and ledipasvir/sofosbuvir for 12 weeks for the treatment of recurrent HCV genotype 1 post-liver transplant. Data are limited on the use of ledipasvir/sofosbuvir without ribavirin. The aim of this study was to evaluate the use of ledipasvir/sofosbuvir without ribavirin for the treatment of recurrent hepatitis C virus post-liver transplant. METHODS This is a retrospective study of liver transplant patients who received ledipasvir/sofosbuvir without ribavirin for the treatment of recurrent hepatitis C virus in our liver center from 2014 to 2016. RESULTS A total of 60 patients were enrolled of which 70% were male, 88% Caucasian, age 60 ± 7 years, 15% cirrhotic, and 45% treatment-experienced with recurrent hepatitis C virus infection genotype 1 post-liver transplant. Treatment duration varied from 8 to 24 weeks. There were no serious adverse events and no discontinuation of treatment. A total of 71% of patients had undetectable serum hepatitis C virus at 4 weeks. However, irrespective of treatment duration, 100% of patients had undetectable serum hepatitis C virus at the end of treatment and 100% of patients achieved sustained viral response at 12 weeks. CONCLUSION Ledipasvir/sofosbuvir without ribavirin is an effective treatment of recurrent hepatitis C virus infection post-liver transplant. The entire group achieved sustained viral response at 12 weeks irrespective of the length of treatment. The combination of ledipasvir/sofosbuvir was well tolerated without serious adverse effects or discontinuation.
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Affiliation(s)
- Mohamed Shoreibah
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, 1808 7th Ave South, BDB 391, Birmingham, AL, 5294, USA
| | - Jordan Orr
- Department of Internal Medicine, Tinsley Harrison Internal Medicine Residency Program, University of Alabama at Birmingham, 1720 2nd Ave South, BDB 327, Birmingham, AL, 35294, USA.
| | - DeAnn Jones
- The University of Alabama at Birmingham, 1802 6th Ave South, Birmingham, 35233, AL, USA
| | - Jie Zhang
- The University of Alabama at Birmingham, 1802 6th Ave South, Birmingham, 35233, AL, USA
| | - Krishna Venkata
- Department of Medicine, Montgomery Internal Medicine Residency Program, University of Alabama at Birmingham, 2055 E. South Blvd., Suite 200, Montgomery, 36116, AL, USA
| | - Omar Massoud
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, 1808 7th Ave South, BDB 391, Birmingham, AL, 5294, USA
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21
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Globke B, Raschzok N, Teegen EM, Pratschke J, Schott E, Eurich D. Treatment of hepatitis C virus recurrence after transplantation with sofosbuvir/ledipasvir: The role of ribavirin. Transpl Infect Dis 2017; 19. [PMID: 27943544 DOI: 10.1111/tid.12647] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 08/27/2016] [Accepted: 09/12/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) recurrence after liver transplantation (LT) used to be a serious problem in the era of interferon-based treatment. Since the introduction of modern directly acting antivirals, treatment has become easier and shorter. According to published data, in the natural course of hepatitis C infection the duration of antiviral treatment with sofosbuvir (SOF) and ledipasvir (LDV) may be shortened to 12 instead of 24 weeks, using ribavirin (RBV) in addition. Furthermore, the question of whether or not RBV is really necessary, in a 12-week SOF/LDV treatment in the post-transplant setting, is still unanswered. PATIENTS AND METHODS At our institution, 100 liver transplant patients with HCV recurrence underwent interferon-free SOF-based treatment. A total of 51 patients received SOF/LDV with or without RBV. Twenty-nine HCV genotype 1 or 4 patients with histologically proven stage 0-2 fibrosis were treated with SOF/LDV for 12 weeks; another 22 patients with advanced fibrosis (stage 3-4) either received SOF/LDV plus weight-adjusted RBV or prolonged treatment for 24 weeks. RESULTS End of treatment response and sustained virological response (SVR) were achieved in 100% of the 51 patients, irrespective of the treatment group. Patients with prolonged treatment duration or with RBV developed significantly more adverse events (AEs) compared to the SOF/LDV group: 19 (86.4%) vs 8 (27.6%), P<.001. One of the predominant and most relevant AEs was the development of anemia in 43.1% of 10 patients receiving RBV, which was a significant result (P<.001). RBV co-medication had to be reduced in 11 (55%) patients and then stopped in 8 (40%) patients because of AEs. No significant difference was observed among the groups regarding kidney function. CONCLUSION The SOF/LDV combination is a reliable therapy of recurrent HCV infection after LT. It is easy to administer and to achieve SVR in immunocompromised patients without interactions with immunosuppressive medications. Considering the high rate of AEs, frequent discontinuation of RBV treatment, and the 100% SVR, the use of RBV as co-medication in a 12-week SOF/LDV regimen does not seem to be justified after LT.
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Affiliation(s)
- Brigitta Globke
- General, Visceral and Transplant Surgery, Charité Campus Virchow, Berlin, Germany
| | - Nathanael Raschzok
- General, Visceral and Transplant Surgery, Charité Campus Virchow, Berlin, Germany
| | - Eva-Maria Teegen
- General, Visceral and Transplant Surgery, Charité Campus Virchow, Berlin, Germany
| | - Johann Pratschke
- General, Visceral and Transplant Surgery, Charité Campus Virchow, Berlin, Germany.,General, Visceral, Thoracic and Vascular Surgery, Charité Campus Mitte, Berlin, Germany
| | - Eckart Schott
- Gastroenterology and Hepatology, Charité Campus Virchow, Berlin, Germany
| | - Dennis Eurich
- General, Visceral and Transplant Surgery, Charité Campus Virchow, Berlin, Germany
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22
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McCarty TR, Lim JK. Developing therapies to treat hepatitis C infection in post-liver transplant recipients. Expert Opin Pharmacother 2017; 18:165-174. [PMID: 28024124 DOI: 10.1080/14656566.2016.1276564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Currently, hepatitis C virus (HCV) infection remains the most common indication for liver transplant in the United States (US) with almost universal HCV recurrence in the post-liver transplant setting. Previous interferon (IFN)-related efficacy and tolerability concerns about worsening liver function have limited treatment options for many patients with HCV-associated decompensated liver disease and post-liver transplant recipients. However, the last decade has seen a seen a radical shift in the management of HCV with multiple direct-acting antiviral (DAA) treatments that provide more effective, all-oral, IFN-free alternatives. Areas covered: This review will serve to highlight the various pharmacotherapies available to clinicians for patients with HCV recurrence post-liver transplant. A brief history of prior regimens is provided with evidence for newer treatments presented. Also detailed are updated guidelines from societal organizations. Finally, timing of HCV treatment is discussed as the decision to treat patients in a pre or post-liver transplant setting remains challenging. Expert opinion: While there are many potential available therapies for HCV recurrence in the post-liver transplant setting, daclatasvir/sofosbuvir and ledipasvir/sofosbuvir have been the most extensively studied. Newer, pangenotypic generation drugs require more evidence before routine utilization in post-liver transplant recipients.
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Affiliation(s)
- Thomas R McCarty
- a Department of Internal Medicine , Yale University School of Medicine , New Haven , CT , USA
| | - Joseph K Lim
- b Section of Digestive Diseases , Yale University School of Medicine , New Haven , CT , USA
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23
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Castells L, Llaneras J, Campos-Varela I, Bilbao I, Crespo M, Len O, Rodríguez-Frías F, Charco R, Salcedo T, Esteban JI, Esteban-Mur R. Sofosbuvir and daclatasvir in mono- and HIV-coinfected patients with recurrent hepatitis C after liver transplant. Ann Hepatol 2017; 16:86-93. [PMID: 28051797 DOI: 10.5604/16652681.1226819] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
UNLABELLED Background and aims. Pegylated interferon (Peg-INF) and ribavirin (RBV) based therapy is suboptimal and poorly tolerated. We evaluated the safety, tolerability and efficacy of a 24-week course of sofosbuvir plus daclatasvir without ribavirin for the treatment of hepatitis C virus (HCV) recurrence after liver transplantation (LT) in both HCV-monoinfected and human immunodeficiency virus (HIV)-HCV coinfected patients. MATERIAL AND METHODS We retrospectively evaluated 22 consecutive adult LT recipients (16 monoinfected and 6 coinfected with HIV) who received a 24-week course of sofosbuvir plus daclatasvir treatment under an international compassionate access program. RESULTS Most patients were male (86%), with a median age of 58 years (r:58-81y). Median time from LT to treatment onset was 70 months (r: 20-116 m). HCV genotype 1b was the most frequent (45%), 55% had not responded to previous treatment with Peg-INF and RBV and 14% to regiments including first generation protease inhibitors. Fifty-six percent of the patients had histologically proven cirrhosis and 6 had ascites at baseline. All patients completed the 24-week treatment course without significant side effects except for one episode of severe bradicardya, with only minor adjustments in immunosuppressive treatment in some cases. Viral suppression was very rapid with undetectable HCV-RNA in all patients at 12 weeks. All 22 patients achieved a sustained virological response 12 weeks after treatment completion. CONCLUSION The combination of sofosbuvir plus daclatasvir without ribavirin is a safe and effective treatment of HCV recurrence after LT in both monoinfected and HIV-coinfected patients, including those with decompensated cirrhosis.
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Affiliation(s)
- Lluís Castells
- LIver Unit. Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona. Spain
| | - Jordi Llaneras
- LIver Unit. Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona. Spain
| | - Isabel Campos-Varela
- Universidade de Santiago de Compostela (CLINURSID); Department of Internal Medicine, Hospital of Santiago de Compostela. Santiago de Compostela, Spain
| | - Itxarone Bilbao
- Liver Transplant Unit, Department of HPB-Surgery and Transplant, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona. Spain
| | - Manel Crespo
- Department of Infectious Diseases. Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona. Spain
| | - Oscar Len
- Department of Infectious Diseases. Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona. Spain
| | - Francisco Rodríguez-Frías
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
| | - Ramon Charco
- Liver Transplant Unit, Department of HPB-Surgery and Transplant, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona. Spain
| | - Teresa Salcedo
- Pathology Department. Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona. Spain
| | - Juan Ignacio Esteban
- LIver Unit. Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona. Spain
| | - Rafael Esteban-Mur
- LIver Unit. Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona. Spain
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24
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Rubin RA, Russo MW, Brown KA, Fontana RJ, Levitsky J, Vargas H, Yoshida EM, Brown RS. Twice-Daily Telaprevir for Posttransplant Genotype 1 Hepatitis C Virus: A Prospective Safety, Efficacy, and Pharmacokinetics Study. EXP CLIN TRANSPLANT 2016; 16:182-190. [PMID: 27855589 DOI: 10.6002/ect.2016.0251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Our objective was to determine the safety, efficacy, and pharmacokinetics of telaprevir plus pegylated interferon alfa 2a and ribavirin for chronic, posttransplant genotype 1 hepatitis C virus infection. MATERIALS AND METHODS A prospective, single-arm, multicenter, open-label, phase 2b study was conducted at 22 North American sites to assess the safety, efficacy, and pharmacokinetics of pegylated interferon alfa 2a, ribavirin, and twice daily telaprevir in liver transplant recipients with recurrent, chronic hepatitis C without cirrhosis. Baseline liver biopsies were read by a central pathologist. There were planned safety reviews after a sentinel cohort reached treatment weeks 4 and 16. Serial pharmacokinetic sampling was performed for calcineurin inhibitors, telaprevir, and ribavirin. RESULTS Sixty-one patients were enrolled and received ≥ 1 dose of study medication; 37 (61%) achieved sustained virologic response. Thirteen of 18 treatment-naive patients (72%), 10 of 11 patients with no or minimal fibrosis (91%), 13 of 15 patients (87%) with interleukin 28B genotype CC, and 36 of 45 patients (80%) with either undetectable or unquantifiable hepatitis C virus RNA at treatment week 4 achieved sustained virologic response. Nine patients (15%) had ≥ 1 drug-related serious adverse event and 7 (11%) discontinued all study drugs due to an adverse event. There were no deaths or acute cellular rejection episodes. During telaprevir treatment, median doses of tacrolimus and cyclosporine were 0.5 mg weekly and 25 mg daily. Target exposures were achieved for telaprevir with twice daily dosing and for ribavirin with reduced initial dosing. CONCLUSIONS Telaprevir combination therapy for posttransplant hepatitis C virus infection yielded superior efficacy than historical controls. Adverse events were similar to, but exceeded, those in immunocompetent patients. Calcineurin inhibitor dosing levels were substantially reduced with telaprevir.
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Affiliation(s)
- Raymond A Rubin
- From the Piedmont Transplant Institute, Piedmont Hospital, Atlanta, Georgia, USA
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25
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Stepanova M, Sayiner M, de Avila L, Younoszai Z, Racila A, Younossi ZM. Long-term outcomes of liver transplantation in patients with hepatitis C infection are not affected by HCV positivity of a donor. BMC Gastroenterol 2016; 16:137. [PMID: 27846801 PMCID: PMC5111255 DOI: 10.1186/s12876-016-0551-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 10/29/2016] [Indexed: 12/22/2022] Open
Abstract
Background The use of HCV-positive livers for HCV-positive recipients is becoming more common. Our aim is to evaluate long-term outcomes in liver transplant recipients transplanted with HCV antibody-positive organs. Methods From the Scientific Registry of Transplant Recipients (1995–2013), we selected all adult liver transplant recipients with HCV, and cross-sectionally compared long-term graft loss and mortality rates between those who were transplanted from HCV antibody-positive (HCV+) vs. HCV antibody-negative donors. Results We included 33,668 HCV+ liver transplant recipients (54.0 ± 7.7 years old, 74.1% male, 71.0% white, 23.6% with liver malignancy). Of those, 5.7% (N = 1930) were transplanted from HCV+ donors; the proportion gradually increased from 2.9% in 1995 to 9.4% in 2013. Patients who were transplanted from HCV+ positive donors were more likely to be discharged alive after transplantation (95.4% vs. 93.9%, p = 0.006), but this difference was completely accounted for by a greater proportion of HCV+ donors in more recent study years (p = 0.10 after adjustment for the transplant year). After transplantation, both mortality in HCV patients transplanted from HCV+ donors (12.5% in 1 year, 24.2% in 3 years, 33.0% in 5 years) and the graft loss rate (2.2% in 1 year, 4.8% in 3 years, 7.5% in 5 years) were similar to those in HCV patients transplanted from HCV-negative donors (all p > 0.05). Conclusions Over the past two decades, the use of HCV+ organs for liver transplantation has tripled. Despite this, the long-term outcomes of HCV+ liver transplant recipients transplanted from HCV+ donors were not different from those who were transplanted with HCV-negative organs. Electronic supplementary material The online version of this article (doi:10.1186/s12876-016-0551-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Stepanova
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Claude Moore Health Education and Research Building 3300 Gallows Road, Falls Church, VA, 22042, USA.,Center for Outcomes Research in Liver Diseases, Washington, DC, USA
| | - Mehmet Sayiner
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Claude Moore Health Education and Research Building 3300 Gallows Road, Falls Church, VA, 22042, USA
| | - Leyla de Avila
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Claude Moore Health Education and Research Building 3300 Gallows Road, Falls Church, VA, 22042, USA
| | - Zahra Younoszai
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Claude Moore Health Education and Research Building 3300 Gallows Road, Falls Church, VA, 22042, USA
| | - Andrei Racila
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Claude Moore Health Education and Research Building 3300 Gallows Road, Falls Church, VA, 22042, USA
| | - Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Claude Moore Health Education and Research Building 3300 Gallows Road, Falls Church, VA, 22042, USA. .,Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.
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26
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Weiler N, Zeuzem S, Welker MW. Concise review: Interferon-free treatment of hepatitis C virus-associated cirrhosis and liver graft infection. World J Gastroenterol 2016; 22:9044-9056. [PMID: 27895394 PMCID: PMC5107588 DOI: 10.3748/wjg.v22.i41.9044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 08/09/2016] [Accepted: 10/19/2016] [Indexed: 02/06/2023] Open
Abstract
Chronic hepatitis C is a major reason for development of cirrhosis and hepatocellular carcinoma and a leading cause for liver transplantation. The development of direct-acting antiviral agents lead to (pegylated) interferon-alfa free antiviral therapy regimens with a remarkable increase in sustained virologic response (SVR) rates and opened therapeutic options for patients with advanced cirrhosis and liver graft recipients. This concise review gives an overview about most current prospective trials and cohort analyses for treatment of patients with liver cirrhosis and liver graft recipients. In patients with compensated cirrhosis Child-Pugh-Turcotte (CTP) class A, all approved agents are safe and SVR rates do not significantly differ from patients without cirrhosis in general. In patients with decompensated cirrhosis CTP class B or C, daclastasvir, ledipasvir, velpatasvir, and sofosbuvir are approved, and SVR rates higher than 90% can be achieved. Especially for patients with a model of end stage liver disease score higher than 15 and therefore eligible for liver transplantation, data is scarce. Reported SVR rates in patients with cirrhosis CTP class C are lower compared to patients with a less severe liver disease. In liver transplant recipients with a maximum of CTP class A, SVR rates are comparable to patients without LT. Patients with decompensated graft cirrhosis should be treated on an individual basis.
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27
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Gimeno-Ballester V, Simón MÁ, Trigo C, Mar J, San Miguel R. Sofosbuvir plus simeprevir for the treatment of genotype 1 chronic hepatitis C: a review of evidence. Expert Rev Gastroenterol Hepatol 2016; 10:1289-1303. [PMID: 27626505 DOI: 10.1080/17474124.2016.1236682] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sofosbuvir (SOF) with simeprevir (SIM) combination was the first interferon-free regimen that reached optimal results in terms of sustained viral response (SVR). Areas covered: A systematic review of the scientific literature concerning the effects that the SOF/SIM combination had on hepatitis C genotype 1 patients yielded 771 references. After the revision process, four clinical trials and 15 observational studies met the inclusion criteria; in total, these studies involved 5,766 patients. The SVR ranged from 67% to 100% depending on the patients' viral subtype and cirrhosis status. Adverse effects were common, but treatment discontinuation related to drug toxicity occurred in less than 5% of cases. Expert commentary: The SOF/SIM combination exhibits efficacy and tolerability profiles that are similar to those of the other available interferon-free combinations used for non-cirrhotic genotype 1b patients. Meanwhile, for patients with advanced cirrhosis or genotype 1a, this approach cannot be considered a routine treatment option due to the unsatisfactory results.
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Affiliation(s)
- Vicente Gimeno-Ballester
- a Department of Pharmacy , Hospital Universitario Miguel Servet , Zaragoza , Spain.,b Faculty of Pharmacy of the University of Granada , Granada , Spain
| | - Miguel Ángel Simón
- c Department of Digestive Diseases , Hospital Clinico Universitario Lozano Blesa , Zaragoza , Spain
| | - Cristina Trigo
- d Department of Pharmacy , Hospital Royo Villanova , Zaragoza , Spain
| | - Javier Mar
- e Clinical Management Service , Hospital Alto Deba , Mondragón , Spain
| | - Ramón San Miguel
- b Faculty of Pharmacy of the University of Granada , Granada , Spain.,f Department of Pharmacy , Complejo Hospitalario de Navarra , Pamplona , Spain
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28
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Raschzok N, Schott E, Reutzel-Selke A, Damrah I, Gül-Klein S, Strücker B, Sauer IM, Pratschke J, Eurich D, Stockmann M. The impact of directly acting antivirals on the enzymatic liver function of liver transplant recipients with recurrent hepatitis C. Transpl Infect Dis 2016; 18:896-903. [PMID: 27632190 DOI: 10.1111/tid.12606] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/23/2016] [Accepted: 06/29/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The new directly acting antivirals (DAAs) enable all-oral interferon-free treatment of chronic hepatitis C virus (HCV) infection. We here investigated the effect of DAAs on the enzymatic liver function of liver transplant recipients with recurrent hepatitis C. METHODS Twenty-one patients with elevated liver enzymes or advanced fibrosis/compensated cirrhosis caused by recurrent HCV were treated with sofosbuvir either in combination with simeprevir, or in combination with ribavirin or daclatasvir with or without ribavirin for 12 weeks. Biochemical parameters, tacrolimus trough levels, and the maximal liver function capacity (LiMAx) were measured monthly during the treatment and 12 weeks after the end of treatment. RESULTS All patients achieved sustained virological response 12 weeks after the end of the treatment. The transaminases and cholestasis parameters normalized until week 8 of treatment. The mean LiMAx (normal ranges >315 μg/kg/h) increased from 344±142 μg/kg/h before treatment to 458±170 μg/kg/h (P<.0001) at the 12-week follow-up. In parallel, the tacrolimus trough level to dose ratio decreased from 4.68 down to 2.72 (P=.0004). CONCLUSION Antiviral treatment with DAAs enabled sustained elimination of recurrent HCV in liver transplant recipients and was associated with a significant improvement of the enzymatic liver function.
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Affiliation(s)
- Nathanael Raschzok
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Eckart Schott
- Medical Department, Division of Hepatology and Gastroenterology, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anja Reutzel-Selke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Iman Damrah
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Safak Gül-Klein
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Benjamin Strücker
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Igor Maximilian Sauer
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dennis Eurich
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Stockmann
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Evangelisches Krankenhaus Paul Gerhardt Stift, Lutherstadt Wittenberg, Germany
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29
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Management of post liver transplantation recurrent hepatitis C infection with directly acting antiviral drugs: a review. Hepatol Int 2016; 10:749-61. [PMID: 27337961 DOI: 10.1007/s12072-016-9744-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/17/2016] [Indexed: 12/20/2022]
Abstract
Recurrent HCV infection (rHCV) of the liver allograft following transplantation is universal and is associated with poor graft and patient survival in comparison with other indications. Treatment of rHCV infection in the previous era with pegylated interferon and ribavirin was associated with low sustained virological response (SVR) due to poor tolerability, adverse events and graft rejection. Recently, directly acting antiviral drugs (DAA) have been approved for the treatment of hepatitis C infection and a number of clinical trials have been conducted across various centers in the management of rHCV infection of the graft. In this review we discuss about recent studies that have emerged on the use of NS5b polymerase inhibitor, sofosbuvir in combination with second generation protease inhibitor, simeprevir, fixed dose ledipasvir or daclatasvir with or without ribavirin in the treatment of post transplant rHCV infection.
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30
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EXP CLIN TRANSPLANTExp Clin Transplant 2016; 14. [DOI: 10.6002/ect.2015.0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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31
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Campos-Varela I, Moreno A, Morbey A, Guaraldi G, Hasson H, Bhamidimarri KR, Castells L, Grewal P, Baños I, Bellot P, Brainard DM, McHutchison JG, Terrault NA. Treatment of severe recurrent hepatitis C after liver transplantation in HIV infected patients using sofosbuvir-based therapy. Aliment Pharmacol Ther 2016; 43:1319-29. [PMID: 27098374 DOI: 10.1111/apt.13629] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/14/2016] [Accepted: 03/26/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND For liver transplant recipients with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) co-infection, recurrence after LT is associated with a higher risk of graft loss than for HCV mono-infected patients. Prior HCV treatment options were limited by side effects and drug-drug interactions. AIM To evaluate treatment outcomes with sofosbuvir (SOF)-based therapy among HIV/HCV coinfected liver transplant recipients. METHODS Access to SOF and ribavirin (RBV) prior to regulatory approval was attained via an international compassionate access program for transplant recipients with a life expectancy of 1 year or less in the absence of HCV treatment. This report focuses on the short and longer term outcomes in HCV-HIV co-infected liver transplant recipients. RESULTS Twenty patients were treated, nine with early severe recurrence and 11 with cirrhosis. Eleven patients received SOF and RBV, one SOF, RBV and Peg-interferon, three SOF, RBV and simeprevir and five SOF, RBV and daclatasvir. Of the 18 patients who completed treatment, 16 (89%) achieved sustained virological response 12 weeks after the end of treatment (SVR12). Liver function tests (including bilirubin and albumin) improved significantly over time. Nineteen serious adverse events occurred in eight (40%) patients, none of them related to SOF. Two patients died during treatment and another, 1 year after the end of therapy, due to progressive end-stage liver disease. Importantly, HIV suppression was not compromised. No significant drug-drug interactions were reported. CONCLUSIONS Sofosbuvir-based regimens are safe, well-tolerated and provide high rates of SVR in HCV-HIV co-infected patients with severe recurrence after-liver transplant.
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Affiliation(s)
- I Campos-Varela
- Universidade de Santiago de Compostela (CLINURSID), Santiago de Compostela, Spain.,Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,University of California-San Francisco, San Francisco, CA, USA
| | - A Moreno
- Hospital Ramón y Cajal, Madrid, Spain
| | - A Morbey
- Hospital Curry Cabral, Lisbon, Portugal
| | - G Guaraldi
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - H Hasson
- Scientific Institute Ospedale San Raffaele, Milan, Italy
| | - K R Bhamidimarri
- Division of Hepatology, University of Miami-Miller School of Medicine, Miami, FL, USA
| | - L Castells
- CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain.,Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - P Grewal
- Mount Sinai School of Medicine, New York, NY, USA
| | - I Baños
- Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - P Bellot
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.,Hospital General Universitario, Alicante, Spain
| | | | | | - N A Terrault
- University of California-San Francisco, San Francisco, CA, USA
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Sofosbuvir and Simeprevir Treatment of a Stem Cell Transplanted Teenager With Chronic Hepatitis C Infection. Pediatr Infect Dis J 2016; 35:708-10. [PMID: 26928522 DOI: 10.1097/inf.0000000000001122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There have been no previous reports on the use of interferon-free combinations in pediatric patients with chronic hepatitis C infection. An infected adolescent with severe sickle cell disease underwent stem cell transplantation and subsequent treatment with sofosbuvir and simeprevir during ongoing immunosuppression. Despite the emergence of peripheral edema as a side effect, treatment was continued with sustained antiviral response.
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Wirth TC, Manns MP. The impact of the revolution in hepatitis C treatment on hepatocellular carcinoma. Ann Oncol 2016; 27:1467-74. [PMID: 27226385 DOI: 10.1093/annonc/mdw219] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/18/2016] [Indexed: 12/13/2022] Open
Abstract
Hepatitis C infection represents a global health problem affecting ∼200 million chronically infected patients worldwide. Owing to the development of a fibrogenic and inflammatory micromilieu in the liver, hepatitis C virus (HCV)-infected patients are at a high risk of developing fibrosis, cirrhosis and hepatocellular carcinoma (HCC). The advent of direct-acting antiviral agents (DAAs), however, has spurred a revolution in the treatment of HCV patients with sustained viral response (SVR) rates exceeding 90% in real-life settings. Recent clinical trials suggest that these novel treatments will not only alter the epidemiology of HCV infection but also the incidence of HCV-induced complications including hepatic decompensation, liver transplantation and hepatocarcinogenesis. Here, we summarize data from clinical trials carried out in HCV patients with compensated and decompensated cirrhosis and analyze the impact of viral clearance on HCC development and treatment. Finally, we review and discuss current and future treatment options of HCV patients with HCC in pre- and post-transplantation settings.
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Affiliation(s)
- T C Wirth
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover
| | - M P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover German Center for Infectious Diseases (DZIF), Hannover-Braunschweig, Germany
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Jackson WE, Hanouneh M, Apfel T, Alkhouri N, John BV, Zervos X, Zein NN, Hanouneh IA. Sofosbuvir and simeprevir without ribavirin effectively treat hepatitis C virus genotype 1 infection after liver transplantation in a two-center experience. Clin Transplant 2016; 30:709-13. [PMID: 27019204 DOI: 10.1111/ctr.12738] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND The interferon-free antiviral regimen, sofosbuvir (SOF) and simeprevir (SIM) without ribavirin has been reported to achieve high sustained virologic response (SVR) rates with few adverse effects when treating patients with hepatitis C genotype 1 (HCV GT1) infection. However, there is scarcity of safety and efficacy data in this regimen after liver transplantation (LT). AIM AND METHODS We aim to report the safety, tolerability and efficacy of SOF + SIM to treat LT recipients with recurrent HCV GT1 in a multicenter cohort study. RESULTS Eighty-one patients with HCV GT1 met criteria to be considered for treatment. Sixty-seven patients received SOF + SIM following LT to date: 69% male, 39% with HCV RNA >6 000 000 IU/mL, 22% advanced hepatic fibrosis (stage 3-4), 6% cholestatic recurrence. Fifty-eight percent previously failed or did not tolerate interferon-based treatments. Mean time from LT to treatment was 6.1 ± 5.2 yr. All patients had estimated GFR >30 mL/min. Tacrolimus was primary immunosuppression in 84% of patients and minimal immunosuppression dose adjustments were required during treatment. In intention-to-treat analysis, 90% achieved end-of-treatment virologic response and 88% achieved SVR. CONCLUSIONS Sofosbuvir + SIM combination therapy without ribavirin is well tolerated and results in high virologic response rates in recurrent HCV GT1 infection after liver transplantation.
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Affiliation(s)
- Whitney E Jackson
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamad Hanouneh
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Tehilla Apfel
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Naim Alkhouri
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Binu V John
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Xaralambos Zervos
- Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FL, USA
| | - Nizar N Zein
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Ibrahim A Hanouneh
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
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Saab S, Rheem J, Jimenez M, Bau S, Choi G, Durazo F, El Kabany M, Han S, Farid A, Jamal N, Grotts J, Elashoff D, Busuttil RW. Curing Hepatitis C in Liver Transplant Recipients Is Associated with Changes in Immunosuppressant Use. J Clin Transl Hepatol 2016; 4:32-8. [PMID: 27047770 PMCID: PMC4807141 DOI: 10.14218/jcth.2016.00001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/19/2016] [Accepted: 02/24/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS All-oral interferon-free antivirals are highly effective in treating recurrent hepatitis C (HCV) infection in liver transplant (LT) recipients. The aim of the study was to assess immunosuppression needs after achieving a sustained viral response (SVR). METHODS We compared immunosuppression needs before and after achieving a SVR in adult LT recipients treated for recurrent HCV infection with all-oral direct acting agents. RESULTS We identified 52 liver LT treated recipients who achieved a SVR. The median (25th and 75th percentile interquartile range [IQR]) age was 62 years (57.75, 65). Most recipients received tacrolimus (TAC) for their immunosuppressant regimen. After achieving SVR, there was no statistically significant difference in daily dose of TAC unadjusted per weight (p > 0.05). However, there was a statistically significant decrease in daily dose of TAC adjusted per weight, serum levels of TAC, and the product of glomerular filtration rate and TAC. No statistically significant differences in cyclosporine unadjusted/adjusted per weight daily dose or serum levels were noted. CONCLUSIONS Immunosuppression needs were increased for those patients treated with TAC but not cyclosporine. LT recipients prescribed TAC require close monitoring after treatment completion to avoid potential risk of acute rejection.
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Affiliation(s)
- Sammy Saab
- Departments of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Department of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
- Correspondence to: Sammy Saab, Pfleger Liver Institute, UCLA Medical Center, 200 Medical Plaza, Suite 214, Los Angeles, CA 90095, USA. Tel: +1-310-206-6705, Fax: +1-310-206-4197, E-mail:
| | - Justin Rheem
- Department of Medicine at Harbor-University of California at Los Angeles Medical Center, Torrance, California, USA
| | - Melissa Jimenez
- Departments of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
| | - Sherona Bau
- Department of Surgery 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
- Department of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Francisco Durazo
- Departments of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Department of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Mohammed El Kabany
- Departments of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Department of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Steven Han
- Departments of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Department of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
| | - Alexander Farid
- Departments of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
| | - Naadir Jamal
- Departments of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
| | - Jonathan Grotts
- Departments of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
| | - David Elashoff
- Departments of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Department of Biostatistics at the University of California at Los Angeles, Los Angeles, California, USA
| | - Ronald W. Busuttil
- Department of Surgery at the University of California at Los Angeles, Los Angeles, California, USA
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Nguyen NH, Yee BE, Chang C, Jin M, Lutchman G, Lim JK, Nguyen MH. Tolerability and effectiveness of sofosbuvir and simeprevir in the post-transplant setting: systematic review and meta-analysis. BMJ Open Gastroenterol 2016; 3:e000066. [PMID: 26966549 PMCID: PMC4782279 DOI: 10.1136/bmjgast-2015-000066] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 11/18/2015] [Accepted: 11/20/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Outcome data on simeprevir and sofosbuvir (SMV+SOF) in patients with liver transplantation (LT) with hepatitis C virus genotype 1 (HCV-1) are limited with individual studies having a small sample size and limited SVR12 (sustained virological response) data. Our goal was to perform a meta-analysis to study the outcome of SMV+SOF±ribavirin (RBV) in recipients with LT. METHODS In April 2015, we conducted a literature search for 'simeprevir' in MEDLINE/EMBASE and five major liver meetings. We included studies with SVR12 data in ≥5 post-LT mono-infected HCV-1 patients treated with SMV+SOF±RBV. We used random-effects models to estimate effect sizes, and the Cochrane Q-test (p value <0.10) with I(2) (>50%) to assess study heterogeneity. RESULTS We included nine studies with a total of 325 patients with post-LT. Studies included mostly men (59-81%). Pooled SVR12 was 88.0% (95% CI 83.4% to 91.5%). In two studies, HCV-1a patients with mild fibrosis (n=108) had an SVR12 rate of 95.0% (95% CI 82.4% to 98.7%), which was significantly higher than that of HCV-1a patients with advanced fibrosis (n=49) with an SVR12 rate of 81.7% (95% CI 69.8% to 89.5%), OR 4.2 (95% CI 1.1 to 16.1, p=0.03). The most common pooled side effects were: fatigue 21% (n=48/237), headache 9% (n=23/254), dermatological symptoms 15% (n=38/254), and gastrointestinal symptoms 6% (12/193). CONCLUSIONS SMV+SOF±RBV is safe and effective in recipients with LT with HCV-1 infection.
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Affiliation(s)
- Nghia H Nguyen
- School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Brittany E Yee
- School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Christine Chang
- Department of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Minjuan Jin
- Department of Epidemiology and Biostatistics, Zhejiang University School of Public Health, Hang Zhou, China
| | - Glen Lutchman
- Department of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Joseph K Lim
- Yale Liver Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mindie H Nguyen
- Department of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
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Lens S, Mariño Z, Forns X. Beyond the achievement of sustained virological response after liver transplantation. Liver Int 2015; 35:2354-7. [PMID: 26189705 DOI: 10.1111/liv.12915] [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: 02/13/2023]
Affiliation(s)
- Sabela Lens
- Liver Unit, Hospital Clínic, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Zoe Mariño
- Liver Unit, Hospital Clínic, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Xavier Forns
- Liver Unit, Hospital Clínic, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain
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Toussaint-Miller KA, Andres J. Treatment Considerations for Unique Patient Populations With HCV Genotype 1 Infection. Ann Pharmacother 2015; 49:1015-30. [PMID: 26139639 DOI: 10.1177/1060028015592015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To review the literature for the treatment of hepatitis C virus (HCV) genotype 1 in certain populations of patients that require further considerations before therapy initiation. DATA SOURCES A systematic electronic literature search using the MEDLINE database was performed using the search terms hepatitis C, chronic hepatitis C, drug therapy, end stage liver disease, liver transplantation, HIV, hepatitis B, African Americans, renal insufficiency, obesity, pregnancy, and pediatrics. STUDY SELECTION AND DATA EXTRACTION English language studies from January 1985 to March 2015 were considered. Additional references were identified from ongoing trials obtained from clinicaltrials.gov, conference proceedings, online databases, and citations in relevant review articles. DATA SELECTION Direct-acting antivirals are first-line recommendations for the treatment of HCV genotype 1 infection, and these include combinations of sofosbuvir, simeprevir, ledipasvir/sofosbuvir, ombitasvir/paritaprevir/ritonavir plus dasabuvir, and ribarvirin. Historical and clinical data focusing on the treatment of HCV with these agents in the following populations were selected: decompensated cirrhosis, post-liver transplant, HIV, African Americans, obesity, hepatitis B coinfection, renal impairment, pregnancy, and pediatrics. CONCLUSION Depending on the population studied, clinicians must consider differences in efficacy outcomes, potential drug interactions, and adverse effects that patients may experience.
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Khemichian S, Lee B, Kahn J, Noureddin M, Kim B, Harper T, Esmailian Y, Fong TL. Sofosbuvir and Simeprevir Therapy for Recurrent Hepatitis C Infection After Liver Transplantation. Transplant Direct 2015; 1:e21. [PMID: 27500223 PMCID: PMC4946469 DOI: 10.1097/txd.0000000000000531] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 05/30/2015] [Indexed: 01/24/2023] Open
Abstract
UNLABELLED Antiviral therapy for recurrent hepatitis C in liver transplant recipients has been associated with low efficacy, poor tolerability, and drug-drug interactions. Recent approval of various hepatitis C direct-acting antivirals has resulted in improvement of these parameters. We evaluated the efficacy and safety of 12 week all-oral interferon- and ribavirin-free therapy with sofosbuvir and simeprevir. METHODS Thirty-two genotype 1 liver transplant recipients with recurrent hepatitis C infection were retrospectively analyzed. All patients received 12 weeks of sofosbuvir 400 mg and simeprevir 150 mg orally daily. The primary endpoint was sustained virologic response 12 weeks after treatment. RESULTS Sustained virologic response 12 weeks after treatment was achieved in 30 of 32 (94%; 95% confidence interval, 79-99%) patients. All patients enjoyed on-treatment virological response. Both patients who relapsed were cirrhotic, previously treated with Q80K polymorphism. Significant improvements in alkaline phosphatase, albumin, alanine aminotransferase levels, and platelets were seen at 12-week post therapy. Treatment was well tolerated. No grade 3 or 4 adverse events were noted. Headache and fatigue were the most common complaints. CONCLUSION Combination of sofosbuvir and simeprevir for 12 weeks resulted in 94% sustained virological response-12 rates in patients with hepatitis C genotype 1 and was well tolerated.
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Affiliation(s)
- Saro Khemichian
- Liver Transplantation Program, University of Southern California, Los Angeles, CA
- Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, CA
| | - Brian Lee
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jeffrey Kahn
- Liver Transplantation Program, University of Southern California, Los Angeles, CA
- Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, CA
| | - Mazen Noureddin
- Liver Transplantation Program, University of Southern California, Los Angeles, CA
- Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, CA
| | - Brian Kim
- Liver Transplantation Program, University of Southern California, Los Angeles, CA
- Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, CA
| | - Tammy Harper
- Liver Transplantation Program, University of Southern California, Los Angeles, CA
| | - Yvonne Esmailian
- Liver Transplantation Program, University of Southern California, Los Angeles, CA
| | - Tse-Ling Fong
- Liver Transplantation Program, University of Southern California, Los Angeles, CA
- Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, CA
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