Protocol for the Management of Hepatitis C Transferred Through Kidney Transplantation

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Am J Gastroenterol

Keywords

antivirus agent, glecaprevir plus pibrentasvir, sofosbuvir plus velpatasvir, adult, aged, antiviral activity, clinical article, comorbidity, conference abstract, controlled study, deceased donor, delayed graft function, drug combination, female, genotype, glomerulonephritis, graft recipient, graft rejection, hepatitis C, human, kidney graft, kidney transplantation, male, Michigan, middle aged, nucleic acid amplification techniques, protocol, retrospective study, secondary prevention, side effect, therapy

Abstract

Introduction: The effectiveness of direct-acting antiviral (DAA) drugs for treating hepatitis C virus (HCV) infection may substantially increase the number of available organs for transplants by allowing organ transplantation from HCV-positive (HCV1) donors into HCV-negative (HCV-) recipients. This study describes the outcomes of HCV- recipients who received kidneys from HCV1 donors, highlighting the benefits of post-transplant DAA therapy. Methods: This was a single center retrospective case series of all HCV- recipients who underwent kidney transplantation with organs from HCV1 donors at our transplant center from October 2020 to May 2023. Results: There were 11 HCV- recipients who underwent deceased donor kidney transplantation (DDKT) with organs from HCV+ donors: 9 men (82%) and 2 women (18%). There was 1 patient who received both liver and kidney. The median age was 60 years (range 41-76). The mean organ wait time spent on dialysis was 1.9 years. All patients were confirmed HCV- by quantitative nucleic acid amplification test at the time of transplant, and 9 (82%) patients tested HCV+ after transplantation. Of these 9 HCV infections, 6 were genotype 1a, 1 was 1b, and 2 were 2b. Notably, 8 of these 9 patients received DAA therapy for 12 weeks (6 sofosbuvir/velpatasvir and 2 glecaprevir/pibrentasvir), and all 8 patients had undetectable virus at 8 weeks of treatment with no side effects requiring early treatment termination. Also, none developed graft rejection or glomerulonephritis from HCV infection, although 2 patients had delayed graft function that improved. Within 1 year of transplant, 2 of the 8 patients died due to comorbidities unrelated to HCV or transplant. The 1-year survival for all kidney transplant recipients at our center between 2021 and 2022 was 96%. Conclusion: All HCV- patients who received an HCV+ DDKT and were treated with DAA therapy for post-transplant HCV infection had complete resolution of HCV. Patients receiving an HCV+ DDKT underwent transplant much earlier than expected, at around 1.9 years of dialysis waiting (DDKT wait time for type O patients is 5 years in Michigan). Effective DAA therapy now allows kidneys from HCV1 donors to be a safe source of organs for transplantation.

Volume

119

Issue

10

First Page

S1320

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