HCV+ kidneys for HCV+ patients: transplant study yields impressive results

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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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.

Limitations

  • Early results.
  • Small size; short follow-up.