Transplanting Hepatitis C Virus–Infected Versus Uninfected Kidneys Into Hepatitis C Virus–Infected Recipients

Eckman, Mark H.; Woodle, E. Steve; Thakar, Charuhas V.; Paterno, Flavio; Sherman, Kenneth E.

doi:10.7326/m17-3088

Cited by 23 publications

(14 citation statements)

References 36 publications

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“…Gupta and colleagues analyzed the cost of effectiveness of transplanting a HCV‐positive organ and post‐transplant DAA therapy and found that such a strategy resulted in an increased year of life with an expected cost of $100k US dollars less compared to continuing hemodialysis and waiting for a HCV‐negative donor . Eckman's sensitivity analysis suggested that transplant of an HCV‐uninfected donor kidney preceded HCV treatment was preferred only if the additional wait time for an uninfected donor kidney was less than 161 days . Given this cost‐effectiveness and the low risk of transmission from our center's experience, the utilization of aviremic HCV kidneys appears to be an effective strategy to expand the donor pool and to increase transplant volume.…”

Section: Discussionmentioning

confidence: 99%

Use of HCV Ab+/NAT− donors in HCV naïve renal transplant recipients to expand the kidney donor pool

Dao

Cuffy

Kaiser

et al. 2019

Clinical Transplantation

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Hepatitis C (HCV) disease transmission from the use of HCV antibody-positive and HCV nucleic acid test-negative (HCV Ab+/NAT−) kidneys have been anecdotally reported to be absent. We prospectively analyzed kidney transplant (KT) outcomes from HCV Ab+/NAT− donors to HCV naïve recipients under T-cell depleting early steroid withdrawal immunosuppression. Allografts from 40 HCV Ab+/NAT− donors were transplanted to 52 HCV Ab− recipients between July 2016 and February 2018. Thirty-three (82.5%) of donors met Public Health Service (PHS) increased risk criteria. De novo HCV infection was detected at 3 months post-KT in one recipient (1.9%).This was a case of transmission from a HCV Ab+ NAT+ donor with an initial false-negative NAT completed using sample collected on donor hospital admission (day 2). At the time of HCV diagnosis, a stored donor sample collected during procurement (day 4) was tested and resulted NAT-positive. Subsequently, sustained virologic response (SVR) was achieved with 12 weeks of glecaprevir/pibrentasvir. One death with functioning graft at 261 days post-KT was determined not related to HCV or donor factors. This experience provides evidence of a low transmission rate of HCV from HCV Ab+/ NAT− kidney donors, thereby arguing for increasing utilization. K E Y W O R D Sdonor-derived infections, hepatitis C, infection and infectious agents, kidney (allograft) function/dysfunction 2 of 7 | DAO et Al.distinguishing HCV-viremic (Ab+/NAT+) from -aviremic (Ab+/NAT−) donors 4 and recommended that HCV testing is only required between 1 and 3 months post-transplant if there is concern for disease transmission. 5Anecdotal data from small single center studies have reported HCV transmission risk to be negligible from kidney donors who are aviremic. 6-8 However, when a donor is infected with HCV, the infection may take 5-7 days to be detectable by NAT testing, a period of time referred to as the "eclipse period" during which HCV ribonucleic acid (RNA) is undetectable. Guidance from the Disease Transmission Advisory Committee (DTAC) of the OPTN estimates the risk of HCV transmission from a donor who died with immediate needle exposure to be as high as 3% (OPTN 2017). However, the actual risk of transmission associated with transplantation of HCV Ab+ NAT− kidneys remains to be accurately defined. In the case of potential disease transmission, recent development of well-tolerated direct-acting antivirals (DAA) therapy with short treatment durations allow for disease cure. Studies demonstrate that SVR can be achieved post-KT and in patients with renal dysfunction. 9-11The objective of this study was to analyze incidence of HCV transmission and clinical outcomes in HCV naïve KT recipients who received allografts from HCV Ab+/NAT− donors. | ME THODS | Study populationThe University of Cincinnati and the Christ Hospital began offering HCV Ab+/NAT− donor kidneys to HCV naïve KT recipients in July 2016 as a standard of care. HCV naïve status of the candidate was defined as HCV Ab− on serologies obtained during the pre-KT e...

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Section: Discussionmentioning

confidence: 99%

Use of HCV Ab+/NAT− donors in HCV naïve renal transplant recipients to expand the kidney donor pool

Dao

Cuffy

Kaiser

et al. 2019

Clinical Transplantation

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“…No patients had treatment‐related adverse events and none had detectable HCV RNA 12 weeks after treatment . Lastly, a more recent modelling analysis suggests this strategy has the additional benefit of being cost‐effective because transplanting HCV‐infected donor kidneys into HCV‐infected recipients decreases patients’ time on the waitlist and therefore also their time on haemodialysis . While these preliminary data are promising, without large prospective studies, we cannot yet draw conclusions about adopting this strategy on a larger scale.…”

Section: Renal Transplantation With Hcv‐positive Organsmentioning

confidence: 95%

Use of HCV‐infected organs in solid organ transplantation: An ethical challenge but plausible option

Nangia

Borges

Reddy

2019

Journal of Viral Hepatitis

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Due to the unfortunate epidemic of opioid overdose deaths among people who inject drugs (PWID) in North America, there has been an increase in the availability of hepatitis C (HCV)‐positive organs for transplantation and consequently the potential to decrease waiting times for solid organ transplantation if an HCV‐uninfected recipient is willing to accept an HCV‐positive donor. The confidence in this potential new strategy comes as a result of the advent of safe and highly effective pan‐genotypic direct‐acting antivirals (DAAs). This promising strategy has been the most widely studied in kidney transplantation. Liver transplantation has positive results preliminarily, but has even less available data because viable HCV‐infected donor livers are typically transplanted into HCV‐infected individuals. Further, while HCV‐infected heart and lung transplantation, which face additional post‐transplant issues, have shown encouraging results, these studies are small scale and are limited by short‐term follow‐up. Thus, it would be premature to implement this strategy as standard of care without large scale clinical and real‐world trials and longer‐term follow‐up studies. Further, the ethics of this practice need to be considered. While some transplant professionals argue that more harm will be done by not utilizing HCV‐infected organs, others contend that cautiously conducted multi‐centre studies involving extensive post‐transplant follow‐up are paramount prior to endorsing widespread implementation of this strategy. The ethical permissibility of this practice hinges on whether access to DAA therapy can be secured in advance, and prospective recipients understand and accept all the risks associated with acquiring HCV.

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“…An increasing experience has attested to a lack of adverse consequences for graft or recipient when these organs are implanted into already HCV-infected patients. 10 12 In the United States, the consensus is increasingly that HCV therapy is best deferred in HD patients who are transplant candidates to allow receipt of a kidney from an HCVpositive donor. 13 Such a policy is feasible due to the efficacy and tolerability of DAA after renal transplantation.…”

Section: Consequences Of Hcv Infection For An Individual Patient Not mentioning

confidence: 99%

“…Acceptance of an organ from an HCV‐positive donor under the current organ allocation system in the United States can substantially reduce individual waiting times. A recent Markov model endorsed a strategy of acceptance of kidney grafts from HCV‐positive donors for HCV‐infected recipients deferring antiviral therapy until after transplant . In the United States, the consensus is increasingly that HCV therapy is best deferred in HD patients who are transplant candidates to allow receipt of a kidney from an HCV‐positive donor .…”

mentioning

confidence: 99%

HCV in the haemodialysis population: Treat now or later?

Martin

Jadoul

Pol

2019

Journal of Viral Hepatitis

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Transplanting Hepatitis C Virus–Infected Versus Uninfected Kidneys Into Hepatitis C Virus–Infected Recipients

Abstract: Merck Sharp & Dohme and the National Center for Advancing Translational Sciences.

Cited by 23 publications

References 36 publications

Use of HCV Ab+/NAT− donors in HCV naïve renal transplant recipients to expand the kidney donor pool

Use of HCV Ab+/NAT− donors in HCV naïve renal transplant recipients to expand the kidney donor pool

Use of HCV‐infected organs in solid organ transplantation: An ethical challenge but plausible option

HCV in the haemodialysis population: Treat now or later?

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