A Single Center Experience of Concomitant Administration of Sofosbuvir/Velpatasvir and Amiodarone After Heart or Lung Transplantation

Abstract

<h3>Purpose</h3> There is a shortage of donor hearts and lungs available for transplantation. The development of sofosbuvir/velpatasvir (SOF/VEL), an antiviral against the hepatitis C virus (HCV), created an opportunity to expand the donor pool through the use of HCV viremic donors. Atrial fibrillation (AF) is a frequent complication after transplantation. SOF/VEL contains a warning against the concomitant usage of amiodarone and SOF/VEL due to symptomatic bradycardia. We sought to describe our experience with the co-administration of these agents after heart/lung transplantation. <h3>Methods</h3> Retrospective review of patients enrolled in a clinical trial of SOF/VEL after transplantation from HCV viremic donors to seronegative recipients and that received at least a dose of amiodarone. SOF/VEL was initiated on post-operative day 1. The use of amiodarone was at the discretion of the treatment team. We defined bradycardia as a heart rate < 60 bpm. <h3>Results</h3> A total of 11 (8 lung, 3 heart) patients received SOF/VEL and amiodarone. Three (27%) had a history of AF and 7 patients (64%) were on treatment prior to transplant. The median time from SOF/VEL to start of amiodarone was 1.2 days. The median cumulative dose of amiodarone was 9086mg (IQR: 2195 - 10952) over a median duration of concomitant administration of 25 days. While the number of documented bradycardic heart rates was low, 1.2% (90/7573), the majority of patients (64%) experienced at least one bradycardic episode. Of those patients, six (86%) required intervention and five (83%) had received concomitant beta blocker (BB) therapy during their episode, Table 1. All cases of bradycardia resolved after intervention. <h3>Conclusion</h3> The use of amiodarone in patients receiving SOF/VEL frequently resulted in bradycardic episodes; however, these occurred with the addition of BB. In patients requiring the combination of SOF/VEL and amiodarone, consideration is warranted before the addition of other bradycardia inducing medications.