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Supplementary MaterialPost-transplant immune suppression and anti-infective prophylaxisTacrolimus (FK) was administered to achieve a 12-hour serum trough level of 8-10 ng/mL for the first six months post-LT, 5-8 ng/mL from 6-12 months post-transplant and 3-5 ng/mL for > 12 months post-LT. LT recipients with kidney disease received FK with lower goal trough levels (5-8 ng/mL for the first six months post-LT followed by 3-5 ng/mL beyond six months) and mycophenolate mofetil at target dose of 1.5 to 2.0 g daily (or equivalent dosage of mycophenolic acid). All recipients received opportunistic infection (OI) prophylaxis with valganciclovir, trimethoprim-sulfamethoxazole, and nystatin suspension with additional prophylaxis as indicated by plasma CD4+ T lymphocyte cell count/mm3 (CD4) or prior OI.DAA dosesStandard doses of SOF (400 mg daily), SMV (150 mg daily), and RBV (400 mg daily AM, 600 mg daily PM for weight ≤ 75 kg) were utilized.Laboratory MonitoringPlasma hepatitis C virus RNA levels were quantified using COBAS? AmpliPrep/COBAS? TaqMan? HCV Quantitative Test, v2.0 (Roche Diagnostics, Indianapolis, IN; lower limit of detection (LLD) of 15 IU/mL with the exception of one EOT HCV RNA quantification performed at an outside laboratory (LLD 43 IU/mL). HCV genotype (GT) was determined by the VERSANT? HCV Genotype 2.0 Assay (LiPA; Siemens Medical Solutions Diagnostics, Tarrytown, NY).Supplementary Table 1: Specific patient characteristics prior to and during DAA therapy#38#43#44#89#93#94#101#110Age5456394448396067GenderMaleMaleMaleMaleMaleMaleMaleMaleRaceHispanicWhiteHispanicBlackWhiteWhiteWhiteHispanicHCV GT2b1a1aa1b1a1a1a1aPrior IFN-TxYesYesNoYesNoNoNoNoCo-morbiditiesCKDCKD, HCCbObesityCKDCKD, DMCKD, FTT, MSOFcCKD, CAD, HCCbCKD, DM, HCCbHIV Diagnosis19801989200420071993198519851994Risk for HIV/HCV IVDUHemophiliaIVDU, MSMMSMMSMHemophiliaIVDUMSMPrior OIPJP, candidiasisNoneNonePJPNoMACNoneNoneCD4 (%)d184 (17)464 (35)193 (35)324 (35)405 (36)44 (25)360 (27)150 (28)HIV RNAe< 20<2026<20<20<20<20<20Initial cART RegimenABC + 3TC + RALTDF + FTC + EFVTDF + FTC + RALABC + 3TC + EFVTDF + FTC + RALABC + 3TC + RALTDF + FTC + EFVTDF + 3TC + ATV/rcART at DAA StartNo changeTDF + FTC + RALNo changeABC + 3TC + DTGNo changeNo changeTDF + FTC + RALTDF + FTC + RALLT Date7/29/126/7/082/4/1311/26/1312/3/115/29/137/23/094/24/07LT Characteristic/ ComplicationHepatic artery stenosisNoneHCV+ donorNoneDCD graftLiving donor graftRe-do LT for HATNonePost-LT InfectionsCDI, Influenza, PNA, MRSA SSTINoneNoneNoneThrush, CDIE.coli peritonitis w/ bacteremiaSSTINonePrior Graft RejectionNoneMild cellular rejection 6/24/08None – (moderate cellular rejection, post-DAA)Mild cellular rejection12/4/13NoneNoneModerate cellular rejection 8/14/09Moderate cellular rejection 2008Latest Liver Biopsyf3/6/13:F0, A16/1/09:F0, A15/23/13:F0-F1, A112/4/13:Mild ACR1/22/13:F012/23/13:NRH4/25/12:F2, A17/25/13:F0, A1HCV RNAg63,607,8963,547,0682,077,0318,679,8282,212,93037,508,565552,9411,725,138APRI2.090.730.650.410.858.601.091.53FIB-44.272.622.221.292.0216.123.442.19MELD10119121127147CP ScoreN/AN/AN/AN/AN/A11CN/AN/AInitial IS RegimenFK 1 mg AM, 0.5 mg PMFK 1 mg BIDFK 0.5mg BIDFK 5mg BID, MMF 250 mg BIDFK 0.5mg qAM, 1mg qPM; MPA 350 BIDPred 2.5mg QD, FK 0.5mg BIDFK 1.5mg BIDFK 0.5mg q 10 daysIS at DAA StartFK 0.5 mg BIDFK 0.5 mg BIDSameFK 3 mg BID, MMF 250 BIDSameSameSameFK 0.5 mg BIDIS Change During DAAFK 1 mg AM, 0.5 mg PMNoneNone - increased after DAAFK 1 mg BID, MMF 250 BIDNo changeNo changeNone - increased after DAAFK 1 mg BIDDAA Start Date4/15/143/18/145/21/149/25/143/26/141/17/146/1/148/7/14DAA RegimenSOF + RBVSOF + SMVSOF + SMVSOF + SMVSOF + SMVSOF + SMVSOF + SMVSOF + SMVReported Side EffectCongestion, Mild FeverMental fogginessBack painHeadache FatigueUnable to assess - patient intubated Fatigue, peripheral edemaNone reportedOther Adverse EventN/AN/AHeroin relapse. Graft rejection (after DAAs)N/AN/ADeathN/AN/AAbbreviations: DAA, direct-acting antiviral; HCV, hepatitis C virus; GT, genotype; IFN-Tx, interferon-based treatment; CKD, chronic kidney disease (GFR < 60 mL/min/1.73 m2 for ≥ 3 months); HCC, hepatocellular carcinoma; DM, type 2 diabetes mellitus; FTT, failure-to-thrive; MSOF, multi-system organ failure; CAD, coronary artery disease; HIV, human immunodeficiency virus; IVDU, intravenous drug use; MSM, men who have sex with men; OI, opportunistic infection; PJP, pneumocystis jirovecii pneumonia; MAC, mycobacterium avium complex; CD4, CD4+ T-lymphocyte count; cART, combined antiretroviral therapy; ABC, abacavir; 3TC, lamivudine; TDF, tenofovir; FTC, emtricitabine; RAL, raltegravir; DTG, dolutegravir; ATV/r, ritonavir-boosted atazanavir; LT, liver transplant; DCD, donation after cardiac death; HAT, hepatic artery thrombosis; CDI, clostridium difficile infection; PNA, pneumonia; MRSA, methicillin-resistant staphylococcus aureus; SSTI, skin or soft tissue infection; ACR, acute cellular rejection; NRH, nodular regenerative hyperplasia, APRI, AST-to-platelet ratio index; FIB-4, fibrosis-4 score; MELD, model for end-stage liver disease; CP, Child-Pugh; IS, immunosuppression; FK, tacrolimus; MMP, mycophenolate mofetil; MPA, mycophenolic acid; pred, prednisone; SOF, sofosbuvir; RBV, ribavirin; SMV, simeprevir aPre-transplant GT 3, however after LT with HCV+ liver GT 1a confirmedbHCC present prior to LTcPatient with respiratory failure requiring mechanical ventilation, liver failure, recurrent gastrointestinal bleeding, hypotension requiring vasopressor support, protein-calorie malnutrition, extra-vascular volume overload with pleural effusions, ascites and peripheral edemadMeasured in cells/mm3eMeasured in copies/mLfMost recent liver biopsy prior to DAA initiationgMeasured in IU/mL ................
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