Transplantation of kidneys from hepatitis C–infected donors to hepatitis C–negative recipients: Single center experience. Issue 11 (2nd August 2019)

• Record Type: Journal Article
• Authors: Molnar, Miklos Z.; Nair, Satheesh; Cseprekal, Orsolya; Yazawa, Masahiko; Talwar, Manish; Balaraman, Vasanthi; Podila, Pradeep S. B.; Mas, Valeria; Maluf, Daniel; Helmick, Ryan A.; Campos, Luis; Nezakatgoo, Nosratollah; Eymard, Corey; Horton, Peter; Verma, Rajanshu; Jenkins, Ann Holbrook; Handley, Charlotte R.; Snyder, Heather S.; Cummings, Carolyn; Agbim, Uchenna A.; Maliakkal, Benedict; Satapathy, Sanjaya K.; Eason, James D.
• Is Part Of: American journal of transplantation. Volume 19:Issue 11(2019)
• Page Start: 3046
• Page End: 3057
• Publication Date: 2019-08-02
• Subjects: clinical research/practice -- hepatitis C -- infection and infectious agents ‐ viral -- kidney (allograft) function/dysfunction -- kidney transplantation/nephrology; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.15530
• Languages: English
• ISSNs: 1600-6135

Abstract

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 the 5 to 6 log range. One patient developed fibrosing cholestatic hepatitis with complete resolution. All recipients completed antiviral treatment and 100% were HCV RNA–negative and achieved 12‐week sustained virologic response. The estimated GFRs at end of treatment and 12‐week posttreatment were 67 ± 21 mL/min/1.73 m 2 and 67 ± 17 mL/min/1.73 m 2, respectively. Four recipients developed acute rejection. Kidney transplantation from HCV‐infected donors to HCV‐negative recipients should be considered in all eligible patients. Abstract : Transplantation of kidneys from HCV‐infected donors to HCV‐negative recipients, as standard of care, leads to excellent short‐term allograft function and 100% cure rate, but might be associated with relatively high rates of BK, CMV viremia, and consequent development of de novo DSA. Durand et al's editorial is on page 2969 .