Consensus recommendations

Grade

People with post-transplant HCV infection should be treated as soon as possible, as they are at risk of severe complications.

Optimal timing of initiation of treatment has not been established. For people with newly transplanted livers, initiation of treatment about 6 weeks after transplantation is recommended.

Preferred treatment options for chronic HCV infection Gt 1–6 and compensated liver disease after transplantation are (see Table 6):

sofosbuvir + velpatasvir for 12 weeks
glecaprevir + pibrentasvir for 12 weeks^‡
sofosbuvir + velpatasvir + voxilaprevir for 12 weeks (if prior DAA failure)

B1* or B2^†
A1* or B1^†
B1

Preferred treatment options for chronic HCV infection Gt 1- 6 and decompensated liver disease after transplantation are (see Table 5):

sofosbuvir + velpatasvir + ribavirin for 12 weeks

B1* or B2^†

Treatment with sofosbuvir + velpatasvir, sofosbuvir + ledipasvir, or ribavirin does not require dose adjustment of calcineurin inhibitors or mTOR inhibitors.

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 6).

* For Gt 1 HCV.

† For Gt 2, 3, 4 and 6 HCV.

‡ Data supporting the use of glecaprevir + pibrentasvir for 8 weeks in people with no cirrhosis in the post-transplantation setting are limited. Until additional real-world data are available, we continue to recommend a 12-week treatment duration. Treatment for 8 weeks may be considered on a case-by-case basis.