Kidney transplant from hepatitis C viremic donors into aviremic recipients and risk for post‐transplant BK and cytomegalovirus infection

Daloul, Reem; Schnelle, Kendra; Stein, Lauren Von; Logan, April; Singh, Priyamvada; Yenebere, Priya; Pesavento, Todd E.; Washburn, K. W.

doi:10.1111/tid.13887

Cited by 2 publications

(3 citation statements)

References 43 publications

(86 reference statements)

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“…There have been conflicting data on the potential for increased rates of opportunistic viral infections in the setting of HCV transplantation, with the timing of DAA initiation thought to be a relevant variable and earlier DAA initiation felt to reduce the incidence of CMV infection. 8,[10][11][12]32 Given the limitations of this study, we do not have a matched HCV-negative group to compare rates directly. However, our general CMV DNAemia rates are lower than other centers with a delayed antiviral initiation approach.…”

Section: Discussionmentioning

confidence: 99%

“…8 Additionally, in a recent large study of similarly delayed antiviral therapy at a separate institution in the setting of kidney transplantation, CMV DNAemia incidence was similar between HCV-positive and HCV-negative donor groups. 32 Notably, initiating HCV antiviral therapy in the outpatient setting is a time-intensive approach that requires securing DAA financial coverage through a third-party payer. A dedicated pharmacy team at our institution assisted with prior authorizations, appeals, and financial grant applications.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Real-world Experiences in the Transplantation of Hepatitis C-NAAT–positive Organs

Steinbrink,

Byrns,

Berg

et al. 2023

Transplantation Direct

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Background. Hepatitis C virus (HCV) nucleic acid amplification test (NAAT)–positive donors have increased the organ pool. Direct-acting antivirals (DAAs) have led to high rates of treatment success and sustained virologic response (SVR) in recipients with donor-derived HCV infection without significant adverse effects, although variability remains in the timing and duration of antivirals. Methods. This retrospective study analyzed all adult HCV-NAAT–negative transplant recipients who received an organ from HCV-NAAT–positive donors from November 24, 2018, to March 31, 2022, at Duke University Medical Center with protocolized delay of DAA initiation until after hospital discharge, with at least 180-d follow-up on all patients. Transplant and HCV-related outcomes were analyzed. Results. Two hundred eleven transplants (111 kidneys, 41 livers, 34 hearts, and 25 lungs) were performed from HCV-NAAT–positive donors to HCV-NAAT–negative recipients. Ninety percent of recipients became viremic within 7 d posttransplant. Ninety-nine percent of recipients were initiated on pangenotypic DAAs in the outpatient setting a median of 52 d posttransplant, most commonly with 12-wk courses of sofosbuvir–velpatasvir (lungs) and glecaprevir–pibrentasvir (heart, kidney, and liver). Ninety-seven percent of recipients had SVR after a first-line DAA; all ultimately achieved SVR at 12 wk after subsequent treatment courses. The median peak HCV RNA for all organ systems was 2 436 512 IU/mL; the median time from antiviral to undetectable RNA was 48 d, although differences were noted between organ groups. No patient deaths or graft losses were directly attributable to HCV infection. Conclusions. One hundred percent of transplant recipients of HCV-NAAT–positive organs ultimately developed SVR without significant adverse effects when HCV antivirals were initiated in the outpatient setting after transplant hospitalization, suggesting that this real-world treatment pathway is a viable option.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Real-world Experiences in the Transplantation of Hepatitis C-NAAT–positive Organs

Steinbrink,

Byrns,

Berg

et al. 2023

Transplantation Direct

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Management of severe BK viremia in a patient receiving a kidney transplant from a hepatitis C virus–positive donor: A case report

Gray,

Borges,

Conrath

et al. 2023

American Journal of Health-System Pharmacy

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Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose A case of BK nephropathy in a kidney transplant recipient who received an organ from a hepatitis C virus (HCV)–positive donor is reported. Summary A 66-year-old male negative for HCV with chronic kidney disease secondary to diabetic glomerulosclerosis received a kidney transplant from an HCV-viremic donor. His initial postoperative course was uncomplicated, and HCV treatment with glecaprevir/pibrentasvir was initiated after discharge. On postoperative day (POD) 60, the patient developed BK viremia and his mycophenolate mofetil dose was decreased. Over the next few months, the BK viral load increased, with mycophenolate mofetil stopped and the tacrolimus goal lowered in response. On POD 130, the patient was admitted for a hypertensive crisis and found to have decreased renal function. During this hospitalization, the patient received a course of intravenous immune globulin (IVIG). Despite an initial response to the modification of immunosuppression therapy and several courses of IVIG over the following months, the patient’s renal function continued to decline. At 18 months after transplantation, the patient was restarted on dialysis and taken off all immunosuppression. Conclusion Utilization of organs from HCV-positive donors in HCV-negative recipients allows for expansion of the donor pool and facilitates shorter times on the waitlist. Although initial data in HCV-discordant transplantation did not find an increased risk for opportunistic infections, more recent studies have shown that such risk may be present. This case report describes a patient who developed BK viremia and eventual allograft failure after an HCV-discordant transplantation.

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Kidney transplant from hepatitis C viremic donors into aviremic recipients and risk for post‐transplant BK and cytomegalovirus infection

Cited by 2 publications

References 43 publications

Real-world Experiences in the Transplantation of Hepatitis C-NAAT–positive Organs

Real-world Experiences in the Transplantation of Hepatitis C-NAAT–positive Organs

Management of severe BK viremia in a patient receiving a kidney transplant from a hepatitis C virus–positive donor: A case report

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