Consensus recommendations for HCV treatment after liver transplantation

Consensus recommendationsGrade
People with post-transplant HCV infection should be treated as soon as possible, as they are at risk of severe complications.A1
Optimal timing of initiation of treatment has not been established. For people with newly transplanted livers, initiation of treatment at 3–6 months after transplantation is recommended.B1
Preferred treatment options for chronic HCV infection and compensated liver disease after transplantation include (see Table 8):
Gt 1 HCV:
• sofosbuvir + velpatasvir ± ribavirin for 12 weeksB1
• sofosbuvir + ledipasvir ± ribavirin for 12 or 24 weeksA1
• sofosbuvir + daclatasvir ± ribavirin for 12 or 24 weeksB1
• paritaprevir–ritonavir, ombitasvir, dasabuvir ± ribavirin for 24 weeksB1
Gt 2, 3 HCV:
• sofosbuvir + velpatasvir ± ribavirin for 12 weeksB2
• sofosbuvir + daclatasvir ± ribavirin for 12 or 24 weeksB2
Gt 4, 6 HCV:
• sofosbuvir + velpatasvir ± ribavirin for 12 weeksB2
Preferred treatment options for chronic HCV infection and decompensated liver disease or fibrosing cholestatic hepatitis after transplantation include (see Table 8):

Gt 1 HCV:
• sofosbuvir + velpatasvir + ribavirin for 12 weeksB1
• sofosbuvir + ledipasvir ± ribavirin for 12 or 24 weeksA1
• sofosbuvir + daclatasvir ± ribavirin for 12 or 24 weeksB1
Gt 2 HCV:
• sofosbuvir + velpatasvir + ribavirin for 12 weeksB2
Gt 3 HCV:
• sofosbuvir + daclatasvir + ribavirin for 24 weeksB2
Gt 4, 6 HCV:
• sofosbuvir + velpatasvir + ribavirin for 12 weeksB2
Treatment with sofosbuvir + velpatasvir, sofosbuvir + ledipasvir, sofosbuvir + daclatasvir or ribavirin does not require dose adjustment of calcineurin inhibitors or mTOR inhibitors.A2
Treatment with paritaprevir–ritonavir, ombitasvir, and dasabuvir requires dose modification of calcineurin inhibitors; use in combination with mTOR inhibitors is not recommended.A2
Notes: None of the currently available DAAs in Australia include a specific indication for the treatment of HCV infection after transplantation. Recommended or preferred treatment regimens may not be eligible for prescription on the PBS, reflecting the dynamic nature of this area (see Table 8).
 

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