The Use of Hepatitis C Positive Livers in Hepatitis C Negative Liver Transplant Recipients

NCT ID: NCT03819322

Last Updated: 2025-08-12

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 73 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2019-08-15
• Study Completion Date: 2025-03-17

Brief Summary

This is an open-label, pilot trial to test the safety and efficacy of transplantation of livers from Hepatitis C seropositive non-viremic (HCV Ab+/NAT-) and HCV seropositive viremic (HCV Ab+/NAT+) donors to HCV seronegative recipients on the liver transplant waitlist. Treatment and prophylaxis will be administered, using a transmission-triggered approach for the first scenario (HCV Ab+/NAT- donors, arm 1) and a prophylaxis approach for the later scenario (HCV Ab+/NAT+ donors, arm 2).

Detailed Description

This is a prospective, single center, pilot, open-label study of transplantation of livers of HCVAb+ donors to HCVAb- recipients with subsequent therapy with sofosbuvir/velpatasvir (Epclusa®). Recipients of a liver from HCVAb+/NAT- donors will be in arm 1 (the transmission-triggered arm) of the study. In this arm, the study will monitor transmission of HCV by measuring HCV RNA in liver transplant recipients. If HCV RNA is detected, indicating transmission of HCV, recipients will be treated with sofosbuvir/velpatasvir (Epclusa®) for 12 weeks. Virological response will be assessed at 4 weeks, end of treatment and 12 weeks after completion of therapy.

Recipients of a liver from HCVAb+/NAT+ donors will be in arm 2 (the prophylaxis arm) of the study. In this arm, patients will be started on a 12-week course of sofosbuvir/velpatasvir (Epclusa®) immediately post-operatively and will undergo close monitoring of HCV RNA for evidence of transmission.

To be eligible for the study, subjects need to be listed for liver transplantation, be not infected with HCV, HBV or HIV, and sign informed consent.

Conditions

Liver Transplant; Hepatitis C

Study Design

• Allocation Method: NON_RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

HCV seropositive non-viremic (HCV Ab+/NAT-) donor

Liver recipients will be monitored for HCV for one year following transplant. When HCV RNA is detected, the transmission-triggered treatment phase will be initiated.

Recipients will be treated with 12-week oral course of sofosbuvir/velpatasvir (Epclusa®), a fixed-dose combination of a nucleotide analogue HCV NS5B polymerase inhibitor (sofosbuvir - 400mg) and a NS5A inhibitor (velpatasvir - 100mg).

Group Type: EXPERIMENTAL

sofosbuvir/velpatasvir

Intervention Type: DRUG

12 week, oral, fixed dose

HCV seropositive viremic (HCV Ab+/NAT+) donor

Post-operative day 1, liver recipients will be treated with 12-week oral course of sofosbuvir/ velpatasvir (Epclusa®), a fixed-dose combination of a nucleotide analogue HCV NS5B polymerase inhibitor (sofosbuvir - 400mg) and a NS5A inhibitor (velpatasvir - 100mg).

Group Type: EXPERIMENTAL

sofosbuvir/velpatasvir

Intervention Type: DRUG

12 week, oral, fixed dose

Interventions

sofosbuvir/velpatasvir

12 week, oral, fixed dose

Intervention Type: DRUG

Other Intervention Names

Epclusa

Eligibility Criteria

Inclusion Criteria

1. Patients with end-stage liver disease listed for liver transplantation at UPMC.

2. Age ≥ 18

3. No available living liver donor

4. Listed for an isolated liver transplant at UPMC

5. Have panel reactive antibody level of <98%

6. Able to travel to UPMC for routine post-transplant visits and study visits for a minimum of 12 months after transplantation

7. Able to provide informed consent

8. Be willing to use a contraceptive method for a year after transplant

1. HCV antibody positive

2. HCV NAT negative or positive

Exclusion Criteria

1. HIV positive

2. HCVAb or HCV RNA positive

3. Presence of behavioral risk factors for contracting HCV. These behavioral risk factors are current injection drug use, current intranasal illicit drug use, current percutaneous/parenteral exposures in an unregulated setting.

4. Hepatitis B surface antigen positive

5. History of atrial fibrillation requiring the use of amiodarone over the past 12m

6. Receipt of prior organ transplant

7. Waitlisted for a multi-organ transplant

8. Pregnant women

9. Known allergy to sofosbuvir/velpatasvir

10. Any condition, psychiatric or physical, that in the opinion of the investigator would make it unsafe to proceed with transplantation or interfere with the ability of the subject to participate in the study

1. Confirmed HIV positive (positive HIV-1 antibody, positive HIV-2 antibody, positive p24 antigen and/or positive HIV NAT)

2. Confirmed HBV positive (positive hepatitis B surface antigen and/or HBV NAT)

3. Known ongoing therapy for HCV

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of Pittsburgh Medical Center

OTHER

Sponsor Role: collaborator

Fernanda P Silveira, MD, MS

OTHER

Sponsor Role: lead

Responsible Party

Fernanda P Silveira, MD, MS

Professor

Responsibility Role: SPONSOR_INVESTIGATOR

Principal Investigators

Fernanda Silviera, MD

Role: STUDY_DIRECTOR

University of Pittsburgh

Naudia Jonassaint, MD

Role: PRINCIPAL_INVESTIGATOR

University of Pittsburgh

Locations

UPMC

Pittsburgh, Pennsylvania, United States

Countries

United States

Other Identifiers

STUDY19100082

Identifier Type: -

Identifier Source: org_study_id