Hepatitis C Antivirals Safe in Heart Transplant Patients

Direct-acting antiviral (DAA) drugs proved safe and effective for hepatitis C (HCV) patients who had undergone heart transplants, according to new research.

Jia-Horng Kao, MD, PhD, FAASLD, and a team from the National Taiwan University Hospital in Taipei, found that 12 individuals given sofosbuvir combined with ledipasvir (Harvoni) or sofosbuvir (Sovaldi) combined with daclatasvir (Daklinza) achieved a sustained virologic response rate of 100% after 12 weeks.

Interferon-free DAAs have shown excellent efficacy and safety for ordinary patients with chronic HCV infection, the researchers said.

But the effectiveness of these DAAs on heart transplant patients with HCV has not been evaluated, even though the prevalence of the liver-attacking virus among heart recipients ranges from 7% to 18%, according to the study.

Meantime, heart-transplant patients often cannot not tolerate interferon (IFN)-based regimens because of cardiac toxicity and other heart-related problems.

“Because interferon-based therapies have been considered to have low response rates and to be poorly tolerated in heart transplant recipients with HCV infection, novel therapeutic strategies are urgently needed for these patients,” said Kao, president of Taiwan Association for the Study of the Liver (TASL) and chief of the Division of Hepatology/Gastroenterology at the university hospital.

To study such patients, the team enrolled 12 people with chronic HCV infection who had undergone heart transplantation.

Those with HCV genotype 1 received Harvoni while those with genotypes 2 or 6 were given Sovaldi combined with Daklinza. All patients achieved SVR without serious adverse events, although two-thirds had at least 1 adverse effect.

“Our findings provided new evidence that these patients can safely and effectively eradicate HCV by using potent IFN-free agents,” Kao told MD Magazine. “This can greatly improve the long-term health outcome in these patients.”

Commenting on the findings, Ethan M. Weinberg, MD, a professor of medicine at the University of Pennsylvania Perelman School of Medicine, said HCV patients who don’t have cirrhosis should not be excluded from receiving a heart transplant.

“In fact, those with hepatitis C who have decompensated heart failure and require a heart transplant could wait until after their heart transplant to be treated for HCV,” Weinberg told MD Magazine.

This strategy would give patients access to additional HCV-positive organs, provided the transplant center accepts such organs, Weinberg said. He noted that with more young Americans dying from opiate overdoses, the number of potential organ donors with acute HCV has continued to rise.

“Increased use of HCV positive organs would be one way to decrease the average wait time in the solid organ transplants’ waiting lists,” Weinberg and fellow Penn professor, K. Rajender Reddy, MD, wrote in an editorial accompanying the study.

Kao agreed.

“We can improve the post-operative outcome in heart transplant recipients with HCV infection receiving sofosbuvir-based DAA treatment,” Kao said. “Our results can expand the use of HCV-infected heart transplants and improve the organ shortage.”

Further research should include studying the long-term health outcomes in such patients.

“We expect these newer agents to further improve patient care in this special setting,” Kao said.

The study, "Sofosbuvir-based interferon-free direct acting antiviral regimens for heart transplant recipients with chronic hepatitis C virus infection," was published online in Clinical Infectious Diseases last month.

This article was originally published by MD Magazine.