DAAs allow use of HCV+ kidneys in viremic recipients

  • Kapila N & al.
  • J Viral Hepat
  • 18 Nov 2018

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • HCV+ kidneys can be safely transplanted into HCV+ recipients, with subsequent viral eradication by direct-acting antiviral (DAA) therapy.

Why this matters

  • Authors note that growing US opioid epidemic has led to a surge in available HCV+ organs over the past several years.
  • Use of HCV+ organs can reduce waitlist times and expand the donor pool, with positive effects on survival.

Study design

  • Single-center retrospective review of 12 HCV-infected patients (mean age, 63.7 years) who received viremic kidneys and were subsequently treated with ribavirin (RBV)-free ledipasvir/sofosbuvir (LDV/SOF).
  • 2 patients received combined liver/kidney transplant.
  • All received induction immunosuppression with methylprednisolone, followed by prednisone taper and mycophenolate mofetil (MMF); tacrolimus was started shortly after transplant.
  • Funding: None.      

Key results

  • 75% of patients had HCV-1a infection, and 58.3% were treatment-naive; none had previously received DAAs or had cirrhosis.
  • All had estimated glomerular filtration rate >40 mL/minute/1.73 m2, maintained after treatment.
  • Median waitlist time, 74 days.
  • Median time from transplant to DAA initiation, 119 days.
  • 83.3% were treated for 12 weeks; 16.7% received a 24-week regimen.
  • All achieved sustained virologic response at 12 weeks posttherapy (SVR12).
  • No tacrolimus discontinuations or graft rejection occurred.
  • 1 patient required MMF discontinuation for neutropenia.

Limitations

  • Sample size.

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