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Abstract Details
Outcomes of early vs late treatment initiation in solid organ transplantation from hepatitis C virus nucleic acid test-positive donors to hepatitis C virus-uninfected recipients: Results from the HCV-TARGET study
Am J Transplant. 2023 Oct 21:S1600-6135(23)00796-7. doi: 10.1016/j.ajt.2023.10.006.Online ahead of print.
1Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada. Electronic address: wesam.aleyadeh@uhn.ca.
2Transplant Hepatology, Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, New York, USA.
3Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
4Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
5Department of Transplant Hepatology, MedStar Georgetown University Transplant Institute, Washington, District of Columbia, USA.
6Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
7Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, VCU Medical Center, Richmond, Virginia, USA.
8Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
9Biometrics and Data Quality HCV-TARGET Data Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
10Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
11Division of Gastroenterology and Liver Disease, Keck School of Medicine at University of Southern California, Los Angeles, California, USA.
12Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada. Electronic address: Jordan.Feld@uhn.ca.
Abstract
Curative hepatitis C virus (HCV) therapy has increased transplantation from HCV-infected nucleic acid test-positive donors to HCV-uninfected recipients (D+/R-). We evaluated outcomes of early and late HCV treatment among D+/R- nonliver organ transplants. Patients received HCV regimens per local standard (n = 10 sites). Outcomes were compared between early and late treatments. Early treatment regimens (ETR) (n = 56) were initiated pretransplantation to day 7 posttransplant. Late treatment regimens (LTRs) (n = 102) began median 31 (range, 8-114) days posttransplant. There were 79 kidney, 50 lung, 23 heart, and 6 mixed transplants, similar between groups. HCV RNA was quantifiable in 98% of LTR versus 44.6% of ETR recipients (P < .001). Mean (range) days on treatment were 28 (7-93) ETR and 81 (51-111) LTR (P < .0001). There were no virological failures with ETR, but relapse (n = 3) and nonresponse (n = 2) in LTR (P = .16), including fibrosing cholestatic hepatitis postrelapse (n = 1). Sustained virological response was 100% (95% confidence interval, 93.4-100.0) in ETR (n = 54) and 94.9% (95% confidence interval, 88.5-98.3) in LTR (n = 98). Acute rejection occurred in 11 (19.6%) ETR and 25 (24.5%) LTR. In total, 11 HCV-unrelated deaths occurred: 8 ETR and 3 LTR. Organ transplantation from HCV-infected nucleic acid test-positive donors to HCV-uninfected recipients was safe. ETR led to fewer virological failures with shorter treatment duration, supporting recommendations to initiate treatment promptly posttransplant.