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The Impact of Treatment Delay on Hepatitis C Liver Transplant Outcomes

Ian A Booth1, Jacqueline E Clark1, John C LaMattina2

  • 1Department of Pharmacy, 21668University of Maryland Medical Center, Baltimore, MD, USA.

Journal of Pharmacy Practice
|July 22, 2021
PubMed

Insights

Hepatitis C virus (HCV) treatment in liver transplant recipients (LTRs) showed similar graft survival rates. Delayed HCV treatment and rejection management did not impact outcomes, but pharmacist protocols could improve future care.

Area of Science:

  • Hepatology
  • Transplant Surgery
  • Infectious Diseases

Background:

  • Direct-acting antivirals have improved hepatitis C virus (HCV) outcomes in liver transplant recipients (LTRs).
  • Optimal timing for HCV treatment and rejection management in LTRs remains unclear.
  • The role of pharmacists in managing HCV and rejection in LTRs is understudied.

Purpose of the Study:

  • To compare graft and patient survival in HCV-positive versus HCV-negative LTRs.
  • To evaluate rejection rates and sustained virologic response in HCV-positive LTRs.
  • To investigate the impact of delayed HCV treatment on LTR outcomes.

Main Methods:

  • Single-center, retrospective cohort review.
  • Matched 1:1 comparison of 92 HCV-positive LTRs with HCV-negative LTRs.
  • Analysis of 1-year graft/patient survival, rejection rates, and time to HCV treatment.

Main Results:

  • One-year graft and patient survival were similar between HCV-positive and HCV-negative LTRs.
  • HCV-positive LTRs had higher rates of biopsy-proven acute rejection (BPAR), unaffected by pulse steroid treatment.
  • Delayed HCV treatment (5.4-6.4 months post-transplant) did not impact graft or patient survival.

Conclusions:

  • HCV infection does not affect 1-year graft survival in LTRs.
  • Delayed HCV treatment and rejection management strategies did not negatively impact outcomes.
  • Pharmacist-driven protocols could optimize the initiation of HCV treatment in LTRs.

Keywords:
antiviralshepatitisliverrejection and immunosuppression

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