Outcomes of short‐duration antiviral prophylaxis for hepatitis C positive donor kidney transplants. Issue 11 (26th July 2021)

• Record Type: Journal Article
• Authors: Gupta, Gaurav; Yakubu, Idris; Zhang, Yiran; Kimball, Pamela; Kang, Le; Mitchell, Kimberly; Ijioma, Stephen; Carroll, Norman; Patterson, Julie; Shinbashi, Meagan; Kumar, Dhiren; Moinuddin, Irfan; Kamal, Layla; King, Anne; Bhati, Chandra; Levy, Marlon; Cotterell, Adrian; Khan, Aamir; Sharma, Amit; Sterling, Richard
• Is Part Of: American journal of transplantation. Volume 21:Issue 11(2021)
• Page Start: 3734
• Page End: 3742
• Publication Date: 2021-07-26
• Subjects: clinical research/practice -- clinical trial -- complication: infectious -- infection and infectious agents – viral -- infection and infectious agents – viral: hepatitis C -- infectious disease -- kidney transplantation/nephrology; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.16747
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : Trials describing 4‐ to 12‐week courses of direct‐acting antiviral drugs (DAAs) to treat hepatitis C virus (HCV) transmission from infected donors to uninfected kidney transplant recipients (D+/R− transplants) may be limited in "real‐world" application by costs and delayed access to DAAs. We previously reported HCV transmission of 13% among D+/R− transplants with 2‐ to 4‐day pangenotypic sofosbuvir/velpatasvir (SOF/VEL) perioperative prophylaxis, where one patient with HCV transmission was a nonresponder to first‐line full‐course DAA. Here, we report new data with a 7‐day prophylaxis protocol ( N = 50), as well as cumulative treatment and outcome data on all HCV D+/R− transplants ( N = 102). Overall, nine patients (9/102; 9%; 95% CI: 5%–16%) developed HCV transmission, with a significant decline noted in the 7‐day group (2/50; 4%; 95% CI: 0%–13%) compared with 2‐ to 4‐day prophylaxis (7/52; 13%; 95% CI: 5%–25%). All patients with HCV transmission achieved sustained virologic response post full‐course therapy (including one nonresponder from initial trial). A 1:1 matched analysis ( N = 102) with contemporary HCV D−/R− transplants (controls) showed that although the pretransplant wait time was significantly shorter for D+/R− compared with D−/R− (mean: 1.8 vs. 4.4 years; p < .001), there were no differences in infections, rejection, development of de novo donor‐specific antibody, or transplant outcomes up to 6 months of transplant. Abstract : Perioperative prophylaxis using 7 days of a direct‐acting antiviral drug regimen achieves a very low viral transmission rate from hepatitis C viremic donors to naïve kidney transplant recipients who, when compared to a matched cohort that received kidneys from hepatitis C negative donors, experience shorter wait times and equivalent posttransplant outcomes.