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Abstract Details
Kidney Transplantation From Hepatitis C Viremic Deceased Donors to Aviremic Recipients in a Real-world Setting
Beatrice P Concepcion1, Laura A Binari1, Heidi Schaefer1, Scott Rega2, Irene Feurer2, Saed Shawar1, Ruchi Naik3, Laura Hickman4, Jasmine Walker4, Meghan Kapp5, Kelly A Birdwell1, Anthony Langone1, J Harold Helderman1, Bonnie Ann Sarrell1, Guneet Kochar1, Bernard Dubray4, Kristin Smith6, Heather O'Dell6, April DeMers6, Princess Shelton6, Roman Perri7, David Shaffer4, Rachel C Forbes4
Author information
1Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
2Department of Surgery, Department of Biostatistics, Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN.
3Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL.
4Division of Kidney and Pancreas Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
5Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN.
6Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN.
7Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
Abstract
Transplantation of hepatitis C viremic (HCV+) deceased donor kidney transplants (DDKT) into aviremic (HCV-) recipients is a strategy to increase organ utilization. However, there are concerns around inferior recipient outcomes due to delayed initiation of direct-acting antiviral (DAA) therapy and sustained HCV replication when implemented outside of a research setting.
Methods: This was a retrospective single-center matched cohort study of DDKT recipients of HCV+ donors (cases) who were matched 1:1 to recipients of HCV- donors (comparators) by age, gender, race, presence of diabetes, kidney donor profile index, and calculated panel-reactive antibody. Data were analyzed using summary statistics, t-tests, and chi-square tests for between-group comparisons, and linear mixed-effects models for longitudinal data.
Results: Each group consisted of 50 recipients with no significant differences in baseline characteristics. The 6-mo longitudinal trajectory of serum creatinine and estimated glomerular filtration rate did not differ between groups. All recipients had similar rates of acute rejection and readmissions (all P > 0.05). One case lost the allograft 151 d posttransplant because of acute rejection, and 1 comparator died on postoperative day 7 from cardiac arrest. HCV+ recipients initiated DAA on average 29 ± 11 d posttransplant. Ninety-eight percent achieved sustained virologic response at 4 and 12 wks with the first course of therapy; 1 patient had persistent HCV infection and was cured with a second course of DAA.
Conclusions: Aviremic recipients of HCV+ DDKT with delayed DAA initiation posttransplant had similar short-term outcomes compared with matched recipient comparators of HCV- donors.