Liver and Kidney Recipient Selection of Hepatitis C Virus Viremic Donors: Meeting Consensus Report From the 2019 Controversies in Transplantation

Burton, James R.; Terrault, Norah A.; Goldberg, David S.; Bloom, Roy D.; Gilroy, Richard; Heimbach, Julie K.; Brown, Robert S.; Everson, Gregory T.; Rubin, Erin; Wiesner, R; Pomfret, Elizabeth A.

doi:10.1097/tp.0000000000003014

Cited by 22 publications

(20 citation statements)

References 38 publications

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“…A major breakthrough in the last decade to battle the organ shortage was the practice of transplanting kidneys from HCV-viremic donors into HCV-negative patients (HCV D+/R-) followed by direct-acting antiviral therapy. Early data were promising demonstrating decreased waitlist times and access to younger donors with excellent allograft function [ 65 – 67 ]. A recent study of the impact of this newly discovered donor pool on racial minorities and women revealed that once again this population continues to be disadvantaged [ 68 ▪ ].…”

Section: Conclusion (Liver)mentioning

confidence: 99%

Gender disparities in transplantation

Sheikh

Locke

2021

Current Opinion in Organ Transplantation

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Purpose of review Transplantation is the life-saving therapy for patients suffering from end-organ failure, and as such, equitable access to transplantation (ATT) is of paramount importance. Unfortunately, gender/sex-based disparities exist, and despite the transplant community's awareness of this injustice, gender/sex-based disparities have persisted for more than two decades. Importantly, no legislation or allocation policy has addressed inequity in ATT that women disproportionately face. In fact, introduction of the model for end-stage liver disease-based liver allocation system in 2002 widened the gender disparity gap and it continues to be in effect today. Moreover, women suffering from kidney disease are consistently less likely to be referred for transplant evaluation and subsequently less likely to achieve a kidney transplant, yet they comprise the majority of living kidney donors. Recent findings Acknowledging gender/sex-based disparities in ATT is the first step toward interventions aimed at mitigating this long-standing injustice in healthcare. Summary This article provides a background of end-stage liver and kidney disease in women, summarizes the existing literature describing the issue of gender disparity in ATT, and identifies potential areas of intervention and future investigation.

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Section: Conclusion (Liver)mentioning

confidence: 99%

Gender disparities in transplantation

Sheikh

Locke

2021

Current Opinion in Organ Transplantation

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“…The recent availability of DAAs has led a paradigm shift in the management of posttransplant hepatitis C. DAAs give the opportunity to expand the donor pool for kidney transplant; however, the optimal timing for the initiation of DAA therapy post-kidney transplant is still controversial [50,51]. It is clear that the frequency of AEs is related to various factors including patient selection, among others; nonetheless, it appears from Table 4 that the frequency of AEs is greater when DAAs are not given in the early post-kidney transplant phase.…”

Section: Kidney Transplant From Hcv/nat-positive Donors To Naïve Recipients: Pros and Consmentioning

confidence: 99%

Updated View on Kidney Transplant from HCV-Infected Donors and DAAs

2021

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Background: The discrepancy between the number of potential available kidneys and the number of patients listed for kidney transplant continues to widen all over the world. The transplant of kidneys from hepatitis C virus (HCV)-infected donors into HCV naïve recipients has grown recently because of persistent kidney shortage and the availability of direct-acting antiviral agents. This strategy has the potential to reduce both waiting times for transplant and the risk of mortality in dialysis. Aim: We made an extensive review of the scientific literature in order to review the efficacy and safety of kidney transplant from HCV-viremic donors into HCV naïve recipients who received early antiviral therapy with direct-acting antiviral agents (DAAs). Results: Evidence has been rapidly accumulated on this topic and some reports have been published (n = 11 studies, n = 201 patients) over the last three years. Various combinations of DAAs were administered—elbasvir/grazoprevir (n = 38), glecaprevir/pibrentasvir (n = 110), and sofosbuvir-based regimens (n = 53). DAAs were initiated in a range between a few hours before renal transplant (RT) to a median of 76 days after RT. The sustained virological response (SVR) rate was between 97.5% and 100%. A few severe adverse events (SAEs) were noted including fibrosing cholestatic hepatitis (n = 3), raised serum aminotransferase levels (n = 11), and acute rejection (n = 7). It remains unclear whether the AEs were related to the transmission of HCV, the use of DAAs, or kidney transplant per se. It appears that the frequency of AEs was greater in those studies where DAAs were not given in the very early post-kidney transplant phase. Conclusions: The evidence gathered to date encourages the expansion of the kidney donor pool with the adoption of HCV-infected donor organs. We suggest that kidney transplants from HCV-viremic kidneys into HCV-uninfected recipients should be made in the context of research protocols. Many of the studies reported above were externally funded and we need research generating “real-world” evidence. The recent availability of pangenotypic combinations of DAAs, which can be given even in patients with eGFR < 30/min/1.73 m2, will promote the notion that HCV-viremic donors are a significant resource for kidney transplant.

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“…BeLIAC consider DAAs as an opportunity to the transplant community to solve the HCV problem in donors but there is ongoing debate of how to make the best use of this landmark medical breakthrough for our patients awaiting a liver transplant (95). Many questions remain to be answered and we clearly need to unit forces to make this new challenge a success story.…”

Section: Definition Of An Hcv+ Donormentioning

confidence: 99%

Innovations in liver transplantation in 2020, position of the Belgian Liver Intestine Advisory Committee (BeLIAC)

Dahlqvist¹,

Moreno²,

Stärkel³

et al. 2021

AGEB

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Liver transplantation (LT) remains the only curative option for patients suffering from end-stage liver disease, acute liver failure and selected hepatocellular carcinomas and access to the LT-waiting list is limited to certain strict indications. However, LT has shown survival advantages for patients in certain indications such as acute alcoholic hepatitis, hepatocellular carcinoma outside Milan criteria and colorectal cancer metastases. These newer indications increase the pressure in an already difficult context of organ shortage. Strategies to increase the transplantable organ pool are therefore needed. We will discuss here the use of HCV positive grafts as the use of normothermic isolated liver perfusion. Belgian Liver Intestine Advisory Committee (BeLIAC) from the Belgian Transplant Society (BTS) aims to guarantee the balance between the new indications and the available resources.

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Liver and Kidney Recipient Selection of Hepatitis C Virus Viremic Donors: Meeting Consensus Report From the 2019 Controversies in Transplantation

Cited by 22 publications

References 38 publications

Gender disparities in transplantation

Gender disparities in transplantation

Updated View on Kidney Transplant from HCV-Infected Donors and DAAs

Innovations in liver transplantation in 2020, position of the Belgian Liver Intestine Advisory Committee (BeLIAC)

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