Transplantation of kidneys from hepatitis C–infected donors to hepatitis C–negative recipients: Single center experience

Abstract

Our aim was to evaluate the safety of transplanting kidneys from HCV-infected donors in HCV-uninfected recipients. Data collected from 53 recipients in a single center, observational study included donor and recipient characteristics, liver and kidney graft function, new infections and de novo donor-specific antibodies and renal histology. Treatment with a direct-acting antiviral regimen was initiated when HCV RNA was detected. The mean ± SD age of recipients was 53 ± 11 years, 34% were female, 19% and 79% of recipients were white and African American, respectively. The median and interquartile range (IQR) time between transplant and treatment initiation was 76 (IQR: 68-88) days. All 53 recipients became viremic (genotype: 1a [N = 34], 1b [N = 1], 2 [N = 3], and 3 [N = 15]). The majority (81%) of recipients did not experience clinically significant increases (>3 times higher than upper limit of the normal value) in aminotransferase levels and their HCV RNA levels were in | 3047 MOLNAR et AL.

Ultra-short duration direct acting antiviral prophylaxis to prevent virus transmission from hepatitis C viremic donors to hepatitis C negative kidney transplant recipients

“…34 In another larger study (N = 53) of posttransplant therapy started after 8 weeks of kidney transplant, one patient developed fibrosing cholestatic hepatitis amd an additional 20% patients developed significant elevations in alanine transaminase. 35 Taken together, our findings support the concept of a prophylactic strategy that might offer advantages with regards to allo-sensitization as well as minimization of the risk of acute liver injury.…”

Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

“…This includes the necessity of HCV antiviral therapy and the risk of liver disease if such treatment is unavailable or unsuccessful. Additionally, there is a risk of DAA-associated allograft rejection and possible loss, (356)(357)(358)(359)(360)(361)(362) and/or reduced allograft function. (361,(363)(364)(365)(366) Because use of allografts from HCV-viremic donors in HCV-negative recipients is a recent development in transplant medicine, there are no data on possible long-term hepatic and extrahepatic adverse effects associated with HCV exposure, even among those cured of the infection.…”

“…Limited short-term data from liver, (340,357,390,391) kidney, (358,(378)(379)(380)(390)(391)(392)(393)(394) heart, (359,373,390,395) and lung (359,374) transplant programs performing solid organ transplantations involving HCV-viremic donors and HCV-negative recipients are encouraging. However, the overall number of published cases is limited, and treatment approaches varied.…”

“…Known risks include DAA treatment failure with emergence of complex RASs and possible severe or rapidly progressive liver disease. (358,374,396,397) Due to the limited, heterogeneous experience to date and lack of long-term safety data, strong consideration should be given to performing these transplantations under institutional review boardapproved protocols as recommended by the American Society of Transplantation consensus panel. (353) tina Broder, M.S.W., M.p.H.…”

Use of Hepatitis C Nucleic Acid Test–Positive Liver Allografts in Hepatitis C Virus Seronegative Recipients

“…Early reports after discordant HCV transplant suggest the potential for an increased risk of cellular rejection and an increased incidence of both cytomegalovirus (CMV) and fibrosing cholestatic hepatitis (FCH) after kidney transplant. ( 11,12 )…”