Transplantation of Kidneys From Hepatitis C Virus-Infected Donors to Hepatitis C Virus-Negative Recipients: One-Year Kidney Allograft Outcomes

Molnár, Miklós; Azhar, Ambreen; Tsujita, Makoto; Talwar, Manish; Balaraman, Vasanthi; Bhalla, Anshul; Podila, Pradeep; Kothadia, Jiten P.; Agbim, Uchenna; Maliakkal, Benedict; Kövesdy, Csaba P.; Nair, Satheesh; Eason, James D.

doi:10.1053/j.ajkd.2020.10.017

Cited by 30 publications

(60 citation statements)

References 18 publications

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“…30 Likewise, Molnar et al recently reported on their center's 1-year allograft outcomes of recipients of kidneys from HCV-viremic donors, which were not different from outcomes for those who received a kidney from an HCV-negative donor. 55 Although unmeasured confounding is possible if centers carefully selected the HCV-viremic kidneys in ways not captured by the analyses above, these results regarding short-term allograft function are nonetheless reassuring.…”

Section: Hcv Infection Post-transplantation and Treatment-related Outcomesmentioning

confidence: 99%

“…However, the sample size of that study was likely too small to detect a clinically meaningful difference in the risk for acute rejection, and surveillance donor-specific antibody screening was not done in all of the study patients. 55 The mechanistic hypothesis underlying this potential increase in the risk of CMV activation is that HCV infection may create an environment in the host that enhances secondary viral infection. It is also proposed that HCV acute infection could increase the expression of injury molecules on infected cells, rendering them more visible for immunesystem recognition.…”

Section: Hcv Infection Post-transplantation and Treatment-related Outcomesmentioning

confidence: 99%

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A review of kidney transplantation from HCV-viremic donors into HCV-negative recipients

Daloul

Pesavento

Goldberg

et al. 2021

Kidney International

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Section: Hcv Infection Post-transplantation and Treatment-related Outcomesmentioning

confidence: 99%

Section: Hcv Infection Post-transplantation and Treatment-related Outcomesmentioning

confidence: 99%

A review of kidney transplantation from HCV-viremic donors into HCV-negative recipients

Daloul

Pesavento

Goldberg

et al. 2021

Kidney International

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“…Moreover, a study of decision‐making by HCV‐naïve candidates suggested that most were willing to accept HCV‐infected kidneys under at least some circumstances, such as a kidney from a young donor 11,12 . A single‐center trial and national cohort studies using OPTN registry data have demonstrated that 1‐year allograft function after transplantation is similar between recipients of HCV‐infected kidneys and recipients of kidneys from matched donors without HCV 4,5,9,13 . However, important concerns have emerged suggesting that donor‐derived HCV viremia might be associated with unexpected immunological complications such as BK polyomavirus (BKPyV) infection 4 …”

Section: Introductionmentioning

confidence: 99%

“…11,12 A singlecenter trial and national cohort studies using OPTN registry data have demonstrated that 1-year allograft function after transplantation is similar between recipients of HCV-infected kidneys and recipients of kidneys from matched donors without HCV. 4,5,9,13 However, important concerns have emerged suggesting that donor-derived HCV viremia might be associated with unexpected immunological complications such as BK polyomavirus (BKPyV) infection. 4 Human BKPyV is frequently found in the urine of healthy individuals.…”

Section: Introductionmentioning

confidence: 99%

Association of donor hepatitis C virus infection status and risk of BK polyomavirus viremia after kidney transplantation

Molnar

Potluri

Schaubel

et al. 2022

American Journal of Transplantation

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Kidney transplantation (KT) from deceased donors with hepatitis C virus (HCV) into HCV‐negative recipients has become more common. However, the risk of complications such as BK polyomavirus (BKPyV) remains unknown. We assembled a retrospective cohort at four centers. We matched recipients of HCV‐viremic kidneys to highly similar recipients of HCV‐aviremic kidneys on established risk factors for BKPyV. To limit bias, matches were within the same center. The primary outcome was BKPyV viremia ≥1000 copies/ml or biopsy‐proven BKPyV nephropathy; a secondary outcome was BKPyV viremia ≥10 000 copies/ml or nephropathy. Outcomes were analyzed using weighted and stratified Cox regression. The median days to peak BKPyV viremia level was 119 (IQR 87–182). HCV‐viremic KT was not associated with increased risk of the primary BKPyV outcome (HR 1.26, p = .22), but was significantly associated with the secondary outcome of BKPyV ≥10 000 copies/ml (HR 1.69, p = .03). One‐year eGFR was similar between the matched groups. Only one HCV‐viremic kidney recipient had primary graft loss. In summary, HCV‐viremic KT was not significantly associated with the primary outcome of BKPyV viremia, but the data suggested that donor HCV might elevate the risk of more severe BKPyV viremia ≥10 000 copies/ml. Nonetheless, one‐year graft function for HCV‐viremic recipients was reassuring.

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“…The optimal duration of DAA and the difference between a prophylactic versus a transmission‐and‐treat approach, where permissive acute HCV infection is introduced from donor to recipient, is still unclear in the setting of KT. Delayed DAA initiation and subsequent HCV viremia might be associated with higher incidences of BK polyomavirus and cytomegalovirus as HCV is known to act as an immune modulator and facilitator for other viral infections 2,8–11 …”

Section: Introductionmentioning

confidence: 99%

Association between ezetimibe usage and hepatitis C RNA levels in uninfected kidney transplant recipients who received hepatitis C infected kidneys

Azhar

Binari

Joglekar

et al. 2021

Clinical Transplantation

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Kidney transplantation (KT) from hepatitis C virus infected (HCV+) donors to HCV negative recipients achieve excellent graft function but have relatively higher rates of post‐KT co‐infections presumably due to prolonged HCV viremia in transmission‐and‐treat approach. Ezetimibe acts as an antagonist of Niemann‐Pick C1‐Like 1 receptor required for HCV entry and theoretically can reduce HCV viremia. However, no data is available to examine the role of ezetimibe as a bridge therapy between KT surgery and direct acting antiviral (DAA) initiation. A retrospective cohort study including 70 HCV+ to HCV negative KT recipients from Methodist University Hospital and Vanderbilt University Medical Center was performed to determine the association between ezetimibe usage and HCV viremia. Twenty patients received ezetimibe daily while 50 patients did not. Primary outcome of study was mean HCV RNA level at 1–2 weeks post‐KT and before initiation of DAA. Median (IQR) viral load (VL) in log copies/ml was one log lower in ezetimibe group versus non‐ezetimibe group (4.1 [3.7–5.3] vs. 5.1 [4.4–5.5], P = .01), and highest VL was also lower in ezetimibe group (4.2 [3.7–5.4] vs. 5.4 [4.7–5.9], P = .006). We concluded that ezetimibe bridge therapy might be associated with reduction in HCV VL while waiting for DAA initiation in HCV+ to HCV negative KT recipients.

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Transplantation of Kidneys From Hepatitis C Virus-Infected Donors to Hepatitis C Virus-Negative Recipients: One-Year Kidney Allograft Outcomes

Cited by 30 publications

References 18 publications

A review of kidney transplantation from HCV-viremic donors into HCV-negative recipients

A review of kidney transplantation from HCV-viremic donors into HCV-negative recipients

Association of donor hepatitis C virus infection status and risk of BK polyomavirus viremia after kidney transplantation

Association between ezetimibe usage and hepatitis C RNA levels in uninfected kidney transplant recipients who received hepatitis C infected kidneys

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