HCV-Infected Kidney Recipients Can Achieve HCV Cure With Positive Renal Outcomes

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These results indicate that donors infected with HCV may be a valuable resource for transplant kidneys.
These results indicate that donors infected with HCV may be a valuable resource for transplant kidneys.

Uninfected patients who receive kidney transplants from hepatitis-C (HCV)-infected donors can achieve HCV cure, good quality of life, and good renal function post-transplant, according to study results published in the Annals of Internal Medicine.

In general, organs from individuals infected with HCV are not considered for transplant, but these results indicate that donors infected with HCV may be a valuable resource for transplant organs.

The study (ClinicalTrials.gov: NCT02743897) included HCV-negative transplant candidates (n=20). Each participant underwent transplant to receive a kidney infected with genotype 1 HCV. They received elbasvir-grazoprevir on post-transplant day 3.

The primary outcome was HCV cure and secondary outcomes included RAND-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) quality-of-life scores and post-transplant renal function.

All participants achieved HCV infection status, with HCV RNA undetectable within 4 weeks of initiating HCV therapy. Transient elevations in amino-transferase levels were observed in 5 participants.

Participant mean PCS and MCS quality-of-life scores had an initial decrease 4 weeks after transplant. By 12-month follow-up, PCS scores increased above pre-transplant levels and MCS scores returned to baseline values.

In order to determine post-transplant renal function, the researchers compared the estimated glomerular filtration rate (eGFR) of study participants with matched recipients of HCV-negative kidneys at 6 and 12 months.

The eGFR rates were similar in the 2 groups, indicating good renal function (6 months: median, 67.5 vs. 66.2 mL/min/1.73 m2; 95% CI for between-group difference, 4.2 to 7.5 mL/min/1.73 m2; 12 months: median, 72.8 vs. 67.2 mL/min/1.73 m2; CI for between-group difference, 7.2 to 9.8 mL/min/1.73 m2).

“Kidneys from HCV-infected donors may represent an important opportunity to expand the donor pool and benefit patients without HCV who are well informed about [the] risks,” the researchers wrote.

Disclosures

The study was sponsored by a grant from Merck to the University of Pennsylvania. Please refer to original text for full list of author disclosures.

Reference

Reese PP, Abt PL, Blumberg EA, et al. Twelve-month outcomes after transplant of hepatitis-C-infected kidneys into uninfected recipients: a single-group trial [published online August 7, 2018]. Ann Intern Med. doi:10.7326/M18-0749

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