HCV-TARGET: DAA regimens safe, effective in LT, KT recipients

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Takeaway

  • HCV treatment with direct-acting antivirals (DAAs) is safe and effective in liver transplant (LT), kidney transplant (KT), and dual liver kidney (DLK) transplant recipients.

Why this matters

  • Real-world cohorts reflect a more diverse population than clinical trials.

Study design

  • Data for 443 transplant recipients (LT, 78%; KT, 14%; DLK, 8%) with HCV participating in HCV-TARGET, a real-world, international, observational study.
  • Most (87%) had HCV-1 (1a, 52%), 42% had cirrhosis, and 54% were treatment-experienced.
  • Primary endpoint was sustained virologic response at 12 wk posttherapy (SVR12).
  • Funding: University of Florida; University of North Carolina; AbbVie; Bristol Myers Squibb; Gilead; GlaxoSmithKline; Janssen; Kadmon; Merck.

Key results

  • Ledipasvir/sofosbuvir (LDV/SOF; Harvoni) ± ribavirin (RBV) was most commonly used (85%), followed by SOF + daclatasvir (Daklinza) ± RBV (9%) and ombitasvir/paritaprevir/ritonavir+dasabuvir (3D; Viekira) ± RBV (6%).
  • Per-protocol data (n=412) showed an SVR12 of 95.9% (LT, 96.6%; KT, 94.5%; DLK, 90.9%).
  • RBV use did not affect SVR12 (P=.46) and was more common with impaired renal function.
  • SVR12 predictors included albumin ≥3.5 g/dL (OR, 4.8), total bilirubin ≤1.2 mg/dL (OR, 4.1), and absence of cirrhosis (OR, 3.2) (P<.001 for all).
  • Only 6 cases of acute rejection occurred during DAA therapy, and 2 afterwards.

Limitations

  • Observational design.