Use of Crushed Glecaprevir/Pibrentasvir in Hepatitis C Positive Donor Heart Transplant Recipients

Abstract

Hepatitis C (HCV) positive donors have expanded the donor pool, though timing of initiation of direct acting anti-viral medications is highly variable across centers. A concern with using glecaprevir/pibrentasvir (GLE/PIB) de novo post transplant is administration in patients unable to swallow pills. We describe our experience with immediate post-transplant use of GLE/PIB in relation to sustained virologic response (SVR) based on route of administration. We analyzed all heart transplants from HCV donors to compare achievement of 12 week SVR in patients who swallowed GLE/PIB tablets to patients who had crushed GLE/PIB at any portion of their therapy. GLE/PIB started in recipients who received HCV NAT positive donor on call to the OR and continued for a total of 8 weeks. If patient was unable to swallow GLE/PIB was crushed and given via enteral tube. Of 76 heart or heart/kidney transplants were performed from 11/2017-5/2019, 26 received a HCV NAT positive donor and treated with GLE/PIB. One patient was excluded who died from sepsis 1 month post transplant despite 2 day HCV clearance and did not complete the course of GLE/PIB, leaving 25 for analysis. Eight patients (32%) received crushed GLE/PIB. Median duration of crushed GLE/PIB was 6 days. No difference was found in SVR or rapidity of clearance in patients who received crushed GLE/PIB. Initiation of GLE/PIB on call to the OR with administration via the oral or ng route post-operatively led to no difference in rapidity of HCV clearance and 100% SVR. Larger studies focusing on the details of drug absorption and kinetics are necessary to confirm these findings.