Consensus recommendations

Consensus recommendations

Grade

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 about 6 weeks after transplantation is recommended.

B1

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

Gt 1 HCV:

  • sofosbuvir + velpatasvir for 12 weeks
  • glecaprevir + pibrentasvir for 12 weeks
  • sofosbuvir + ledipasvir for 12 weeks
  • sofosbuvir + velpatasvir + voxilaprevir for 12 weeks (if prior DAA failure)
  • B1
  • A1
  • A1
  • B1

Gt 2, 3, 4, 6 HCV:

  • sofosbuvir + velpatasvir for 12 weeks
  • glecaprevir + pibrentasvir for 12 weeks
  • sofosbuvir + velpatasvir + voxilaprevir for 12 weeks (if prior DAA failure)
  • B2
  • B1
  • B1

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

Gt 1 HCV:

  • sofosbuvir + velpatasvir + ribavirin for 12 weeks
  • sofosbuvir + ledipasvir ± ribavirin for 12 or 24 weeks
  • B1
  • A1

Gt 2, 3, 4, 6 HCV:

  • sofosbuvir + velpatasvir + ribavirin for 12 weeks
  • B2

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

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 6).