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Management and tolerability of glecaprevir‐pibrentasvir pharmacotherapy in hepatitis C viremic heart and lung transplant recipients
Author(s) -
Lewis Tyler C.,
Gidea Claudia,
Reyentovich Alex,
Angel Luis,
Lesko Melissa,
Pavone Jennifer,
Sureau Kimberly,
Smith Deane E.,
Kon Zachary,
Moazami Nader
Publication year - 2020
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.14030
Subject(s) - medicine , tacrolimus , posaconazole , lung transplantation , interquartile range , hepatitis c , transplantation , tolerability , adverse effect , immunosuppression , basiliximab , gastroenterology , voriconazole , antifungal , dermatology
We conducted a retrospective review of thoracic transplant recipients (22 heart and 16 lung transplant recipients) prospectively enrolled in a single‐center observational study of HCV NAT+ organ transplantation in HCV NAT− recipients. All recipients were treated with 8 weeks of glecaprevir‐pibrentasvir (GP) for HCV viremia in addition to standard triple immunosuppression post‐transplant. Thoracic transplant recipients of HCV NAT− organs were used as a control (24 heart and 22 lung transplant recipients). Our primary outcome was to assess the effect of GP on tacrolimus dose requirements. Secondary objectives included assessing drug interactions with common post‐transplant medications, adverse effects, and the need to hold or discontinue GP therapy. The median tacrolimus concentration‐to‐dose ratio (CDR) in the cohort was 184 (99‐260) during GP therapy and 154 (78‐304) over the first month after GP ( P = .79). Trends in median tacrolimus CDR were similar on a per‐week basis and per‐patient basis. In three instances, concomitant posaconazole and GP led to hyperbilirubinemia and interruption of posaconazole. GP therapy was held in one heart transplant recipient and discontinued in another due to unresolving hyperbilirubinemia. Utilization of GP to treat HCV viremia post–thoracic transplant is feasible and safe, but requires modifications to post‐transplant pharmacotherapy and careful monitoring for adverse effects.