Transplantation Direct (Oct 2021)

Kidney Transplantation From Hepatitis C Viremic Deceased Donors to Aviremic Recipients in a Real-world Setting

  • Beatrice P. Concepcion, MD, MS,
  • Laura A. Binari, MD,
  • Heidi Schaefer, MD,
  • Scott Rega, MS,
  • Irene Feurer, PhD,
  • Saed Shawar, MBBS,
  • Ruchi Naik, MD,
  • Laura Hickman, MD,
  • Jasmine Walker, MD,
  • Meghan Kapp, MD,
  • Kelly A. Birdwell, MD, MSCI,
  • Anthony Langone, MD,
  • J. Harold Helderman, MD,
  • Bonnie Ann Sarrell, MD,
  • Guneet Kochar, MD,
  • Bernard Dubray, MD,
  • Kristin Smith, MSN, RN,
  • Heather O’Dell, MSN, ANP-BC, MMHC,
  • April DeMers, MSN, ACNP-BC,
  • Princess Shelton, APRN, FNP-BC,
  • Roman Perri, MD,
  • David Shaffer, MD,
  • Rachel C. Forbes, MD, MBA

DOI
https://doi.org/10.1097/TXD.0000000000001217
Journal volume & issue
Vol. 7, no. 10
p. e761

Abstract

Read online

Background. Transplantation of hepatitis C viremic (HCV+) deceased donor kidney transplants (DDKT) into aviremic (HCV–) recipients is a strategy to increase organ utilization. However, there are concerns around inferior recipient outcomes due to delayed initiation of direct-acting antiviral (DAA) therapy and sustained HCV replication when implemented outside of a research setting. Methods. This was a retrospective single-center matched cohort study of DDKT recipients of HCV+ donors (cases) who were matched 1:1 to recipients of HCV– donors (comparators) by age, gender, race, presence of diabetes, kidney donor profile index, and calculated panel-reactive antibody. Data were analyzed using summary statistics, t-tests, and chi-square tests for between-group comparisons, and linear mixed-effects models for longitudinal data. Results. Each group consisted of 50 recipients with no significant differences in baseline characteristics. The 6-mo longitudinal trajectory of serum creatinine and estimated glomerular filtration rate did not differ between groups. All recipients had similar rates of acute rejection and readmissions (all P > 0.05). One case lost the allograft 151 d posttransplant because of acute rejection, and 1 comparator died on postoperative day 7 from cardiac arrest. HCV+ recipients initiated DAA on average 29 ± 11 d posttransplant. Ninety-eight percent achieved sustained virologic response at 4 and 12 wks with the first course of therapy; 1 patient had persistent HCV infection and was cured with a second course of DAA. Conclusions. Aviremic recipients of HCV+ DDKT with delayed DAA initiation posttransplant had similar short-term outcomes compared with matched recipient comparators of HCV– donors.