*Purpose: Due to direct acting antivirals (DAAs), hepatitis C virus (HCV) positive patients are now resources for organ transplantation in HCV negative recipients. Our institution initiated a HCV donor positive/recipient negative (D+/R-) protocol that utilizes glecaprevir/pibrentasvir (G/P) in recipients of nucleic acid amplification testing (NAT) positive organs for 12 weeks beginning post-operative day three. Per protocol, NAT negative transplant recipients are initiated on treatment only after developing HCV viremia. Pharmacists play an integral role in G/P insurance approval and the medication acquisition process. The aim of this study is to assess antiviral efficacy and identify common barriers to G/P acquisition.

*Methods: The current study is a single-center, cohort analysis of recipients of a kidney or liver transplant from a HCV positive donor transplanted November 2019-June 2020. The primary objective is to determine rate of sustained virologic response (SVR12). Secondary objectives are to describe G/P cost and evaluate the prior authorization (PA) process.

*Results: Forty patients were included. Most patients were male (73%) African American (40%) renal transplant recipients (63%) who received anti-thymocyte globulin (58%). Thirty-one patients received NAT positive organs and were treated with G/P. The most common genotype was 1a (25%). All patients completed 12 weeks of therapy and achieved end of treatment response. No recipient of a NAT negative organ (n=9) developed viremia within the study period. All treated patients with a full data set available (87%) achieved SVR12. All G/P prescriptions required a PA with most (80%) requiring at least one appeal. The average time to PA approval was 3.35 days (range, 1-12). Pharmacy dispensing data was available for 27 patients indicating most patients required financial assistance (63%). Average copay, per fill, was less than $3.00 with average assistance equaling $1,265, $570 and $397 on each of three fills, respectively (range, $0-$3,892). Amounts rounded to nearest US dollar. Additional data collection is ongoing.

*Conclusions: Preliminary results suggest that the HCV donor positive/recipient negative protocol appears to be safe and effective in abdominal transplant recipients. Pharmacy involvement ensured patients were able to obtain DAA treatment to facilitate discharge.

« Back to 2021 American Transplant Congress