HCV-infected kidney donors could save lives

Originally Published By 2 Minute Medicine®. Reused on Infectious Disease Advisor with permission.
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1. No HCV infection was detected in patients receiving HCV-infected kidneys 12 weeks following treatment.

2. No antiviral treatment-related complications occurred recipients of HCV-infected kidneys.

Evidence Rating Level: 2 (Good)

Study Rundown: Kidney failure and end-stage kidney disease result in significant morbidity and mortality. While kidney transplant is a viable solution for patients with kidney failure, there is a severe shortage of transplant organs. HCV-infected organs from deceased donors are often discarded. The authors of this study aimed to assess the tolerability and feasibility of using direct-acting antivirals (DAAs) in patients receiving kidney transplants from HCV-infected donors to prevent transmission of HCV to donor recipients. It was found that using DAAs resulted in safe pre- and post-kidney transplant. HCV infection was prevented in the recipients of the HCV-infected kidneys as well. Limitations of this study included nonrandomization in the cohort and the study being conducted in a single centre. Furthermore, the number of patients included in the study was small. Overall, the results of the study suggest that with appropriate antiviral prophylaxis, HCV-infected kidneys may be safe to utilize for transplantation for end-stage kidney disease.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Kidney transplantation from an anti-hepatitis C virus antibody-positive donor into an anti-hepatitis C virus antibody-negative recipient: A case report

In-Depth [prospective cohort]: The authors conducted an open-label non-randomized trial involving 10 HCV-negative patients that received a kidney from an HCV-positive donor. All patients received DAA before and after transplant, with the specific antiviral regimen depending on the HCV genotype of the donor. The authors assessed incidence of adverse effects related to DAA treatment, as well as HCV RNA levels in recipients during follow-up. Specifically, HCV RNA was not detected during follow-up meetings after treatment with DAAs. Furthermore, T cell responses did not develop in 7 of the 10 recipients of HCV-infected kidneys, while 3 of the recipients may have developed a T cell response. At the 12 week follow up, 5 of the 10 patients had reactive HCV antibody tests; however, there was no statistically significant association found between donor HCV RNA levels and HCV antibody seroconversion among recipients at week 8 of follow up (p > 0.50). Despite reactive antibody tests, no patients had virologic or clinical evidence of chronic HCV infection at the 12-week follow up.

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