Use of Direct Acting Antiviral Medications in Transplant Recipients Receiving Organs from Hepatitis C Viremic Donors
1The Johns Hopkins Hospital, Baltimore, MD, 2Johns Hopkins Home Care Group, Baltimore, MD, 3Thomas Jefferson Univeristy Hospital, Philadelphia, PA
Meeting: 2020 American Transplant Congress
Abstract number: D-178
Keywords: Hepatitis C, Infection, Medicare, Viral therapy
Session Information
Session Name: Poster Session D: Non-Organ Specific: Viral Hepatitis
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: The availability and high efficacy of direct acting antivirals (DAAs) to treat hepatitis C (HCV) is changing practice in solid organ transplant. A large barrier to using organs from HCV viremic donors is the high cost of DAAs and fear recipients will not have access to HCV treatment post-transplant. The purpose of this study was to evaluate access to DAAs post-transplant and describe the timeline from transplant to initiation of DAA therapy.
*Methods: This was a single center, retrospective study of adult patients from June 2017 to December 2019. Patients included received grafts from HCV viremic and/or HCV antibody positive donors and had a detectable HCV viral load (VL) post-transplant. Recipients with a detectable HCV VL prior to transplant were excluded from the study population.
*Results: Of the thirty-eight patients included, nearly 70% were liver recipients. As of December 5, 2019, thirty-seven patients have received access to and started or completed treatment. One patient is awaiting treatment initiation. The majority of patients (95%) were treated for 12 weeks and 82% were treated with glecaprevir/pibrentasvir. The median time from the DAA prescribing to insurance approval was 6 days and the median time from transplant to start of treatment was 29 days. When compared to a group of recipients with a detectable HCV VL prior to transplant from the same time period, the mean time from transplant to start of treatment was significantly shorter in our study population (33.5 vs 51.4 days, p=0.007). All patients who completed treatment and follow up lab work had undetectable HCV VL 12 weeks after the end of treatment.
*Conclusions: In this study, all recipients who developed HCV following transplant had access to DAA therapy. Insurance approval took less than one week and treatment was initiated within the first month post-transplant for the majority of patients.
| Characteristic |
All patients n=38 |
Commercial n=23 |
Medicare n=13 |
Medicaid n=2 |
p value |
| Prior authorization required, n (%) | 36 (94.7) | 22 (95.7) | 12 (92.3) | 2 (100) | 0.859 |
| Appeal required, n (%) | 9 (23.7) | 4 (17.4) | 4 (30.8) | 1 (50) | 0.442 |
| Time from DAA prescribing to insurance approval, days, median (min-max) |
6 (0-53)
|
6 (0-26) | 5 (0-53) | 31.5 (28-35) | 0.017 |
| Time from transplant to start of treatment, days, median (min-max) | 29 (0-84) | 25 (0-84) | 37.3 (10-57) |
49 (46-52)
|
0.256 |
To cite this abstract in AMA style:
Bova S, Cameron A, Durand C, Katzianer J, LeGrand M, Boyer L, Glorioso J, Toman LP. Use of Direct Acting Antiviral Medications in Transplant Recipients Receiving Organs from Hepatitis C Viremic Donors [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/use-of-direct-acting-antiviral-medications-in-transplant-recipients-receiving-organs-from-hepatitis-c-viremic-donors/. Accessed November 22, 2024.« Back to 2020 American Transplant Congress