Pharmaceutical management of hepatitis B and C in liver and kidney transplant recipients

Table 1 Recommendations for the management of hepatitis B and C infection after liver or kidney transplantation

Chronic hepatitis B	Post-liver transplantation	Prophylaxis and treatment	HBIG (for short term) plus NA1
	Post-kidney transplantation		NAs1
Chronic hepatitis C	Post-liver transplantation	No prophylaxis	Sofosbuvir based regimens or “3D” regimen plus RBV (for genotypes 1 and 4)
	Post-kidney transplantation		Newer direct oral antivirals plus/minus RBV (studies are ongoing)2

¹Frontline analogues are considered entecavir or tenofovir in renal proper doses (consider telbivudine in the presence of renal dysfunction);

²Interferon is contraindicated due to the high risk of allograft rejection. HBIG: Hepatitis B immune globulin; NAs: Nucleos(t)ide analogues; 3D: Paritaprevir (plus ritonavir)/ombitasvir/dasabuvir for genotype 1 and paritaprevir (plus ritonavir)/ombitasvir for genotype 4; RBV: Ribavirin.

Table 2 Main characteristics of the approved direct acting antivirals that are currently used in interferon-free regimens for the treatment of chronic hepatitis C

Name	Category, antiviral activity	Doses	Adjustments
Simeprevir	Second-wave NS3/4A protease inhibitor, genotypes 1 and 4	150 mg daily, orally	No renal adjustment is needed
			Contraindicated in patients with Child-Pugh B/C
			Contraindicated cyclosporine co-administration
Sofosbuvir	NS5B RNA Polymerase nucleotide inhibitor, pangenotypic	400 mg daily, orally	Only in glomerular filtration rate > 30 mL/min
			No CNI adjustment is needed
Daclatasvir	NS5A inhibitor, genotypes 1, 3 and 4	60 mg daily, orally	No renal adjustment is needed
			No CNI adjustment is needed
Ledipasvir	NS5A inhibitor genotypes 1, 3 and 4	90 mg daily, orally (fixed dose with sofosbuvir)	No renal adjustment is needed1
			No CNI adjustment is needed
Dasabuvir	Non-NUC NS5B polymerase inhibitor genotype 1	250 mg every 12 h	No renal adjustment is needed
Paritaprevir/Ritonavir/Ombitasvir	Ritonavir boosted NS3/4A protease inhibitor/NS5A inhibitor, genotypes 1 and 4	75/50/12.5 mg x 2 once daily	No safety data in Child-Pugh B, contraindicated in Child-Pugh C
			Cyclosporine: 20% of pretreatment total daily dose; tacrolimus: 0.2 mg/72 h or 0.5 mg once weekly

¹Ledipasvir in combination with sofosbuvir should not be given in patients with glomerular filtration rate < 30 mL/min. CNI: Calcineurin inhibitor.