- Receipt of HCV+ donor kidneys followed by direct-acting antiviral (DAA) therapy is a viable option for HCV+ patients with end-stage renal disease.
Why this matters
- The approach expanded the donor organ pool, reducing mean waitlist time by ~3.5 y.
- Having normal kidney function facilitates antiviral therapy.
- 6 HCV+ patients (HCV RNA, 2.1-23 million IU/mL) received HCV+ donor single-organ kidney transplant in a US single-center prospective pilot study.
- DAAs were initiated 3-6 mo (mean, 165 d) posttransplant.
- Primary endpoint was sustained virologic response at 12 wk posttherapy (SVR12).
- Funding: None disclosed.
- All 6 patients were male (age 55-64 y); 3 were treatment-experienced.
- Kidney Donor Profile Index score ranged from 24% to 91%.
- 5 patients with HCV-1 received 12 wk of ledipasvir/sofosbuvir (Harvoni) ± ribavirin (RBV); 1 with HCV-2b received 24-wk of sofosbuvir (Sovaldi) + daclatasvir (Daklinza).
- All achieved SVR12, and have functioning grafts at 6 mo to 1-y posttransplant.
- Use of HCV+ kidneys reduced mean waitlist time from 1350 d to 65 d (range, 3-193 d).
- Common adverse events were fatigue (n=3), headache (n=2), and nausea (n=1); both patients with severe anemia had received RBV.
- Early results.
- Small size; short follow-up.