*Purpose: With the advent of highly effective and safe oral Direct acting Antiviral agents (DAAs), several transplant centers have adopted protocols for using HCV positive organs in HCV negative recipients. We aim to perform a systematic review to analyze the role of preemptive DAAs in reducing HCV transmission from an HCV positive donor to a negative recipient post-transplant.

*Methods: We did a web-based search across MEDLINE, EMBASE, GOOGLE SCHOLAR for articles and abstracts published between 2011 and 2019 using key terms “organ transplant” associated “Hepatitis C” and “pre-emptive or Peri-operative Direct acting Antiviral agents.”

*Results: After primary analysis, we included five eligible publications of solid organ transplantation from HCV positive donor to HCV negative recipient with definitive use of preemptive DAAs- before the recipient was declared HCV positive post-transplant. Amongst, 135 included patients (36 lung, 35 heart, 60 kidney, and four combined heart/kidney transplant recipients), 32.5% received the first dose of the DAA immediately post-transplant while 67.5% received it a few hours before transplant surgery. Overall treatment duration ranged from 4 days to 14 weeks with a mean of 4.5 weeks. Available data from 3 of these studies showed the donor-derived transmission of HCV infection in between 12% to 94%, with the least from the most recent study where the duration of DAA was only four days. Pooled data from all the five studies showed that HCV viremia was detectable within 1- 5 days post-transplant, with a mean of 2.5 days, and the mean peak viral load in the post-transplant recipients was 621 IU/ml. Time from initiation of DAAs to undetectable viral load is 7- 14 days with a mean of 9.5 days. Sustained virological response (SVR) at 12 weeks was achieved in 98% of the patients, independent of the type of DAAs used. Most of the studies used pan-genotypic agents for the prophylactic course with additional agents, as indicated by drug resistance. No side effects or immunosuppression concerns or graft dysfunction were reported.

*Conclusions: Our systematic review suggests that prophylactic anti HCV treatment in the immediate peri-operative setting is safe and effective irrespective of organ transplanted. Initiating DAAs in this period can allow for a decrease in HCV transmission and preventing chronic HCV infection in HCV negative recipients, along with shorter treatment duration. These results signify the need for further research efforts in determining the definite duration and combinations of DAAs to mitigate donor-derived HCV transmission.

« Back to 2020 American Transplant Congress