One-Year Transplant Outcomes Similar With Kidneys From HCV+, HCV- Donors

By Anne Harding

December 16, 2020

NEW YORK (Reuters Health) - Outcomes for renal transplants from hepatitis C virus (HCV)-infected donors to HCV-negative recipients are similar to those for HCV-negative patients who receive kidneys from donors without HCV, according to a one-year follow-up study.

"More and more centers are willing to accept these kidneys instead of discarding them," Dr. Miklos Z. Molnar, a transplant nephrologist at James D. Eason Transplant Institute and an associate professor of medicine at University of Tennessee Health Science Center in Memphis, told Reuters Health by phone. "In the last two years, it became more and more like the standard of care."

From 500 to 1,000 kidneys from HCV-infected donors become available in the U.S. each year, Dr. Molnar noted, largely from young people who die from opioid overdoses. Previously, these kidneys were only allocated to recipients with HCV, but as curative treatment is now available with direct-acting antivirals (DAAs), these kidneys can be offered to HCV-negative recipients.

When a person without HCV receives a kidney from an HCV-positive donor, the recipient will undergo DAA treatment to clear the virus, Dr. Molnar explained. "One of the major problems is we didn't have too many studies using control groups."

He and his colleagues compared outcomes from 65 HCV-negative recipients transplanted with a kidney from an HCV-infected donor and 59 HCV-negative individuals who received renal transplants from HCV-negative donors at their center in 2018.

The study's primary outcome, estimated glomerular filtration rate (eGFR) at three, six, nine and 12 months, were similar for the two groups, the researchers report in the American Journal of Kidney Diseases.

Rates of delayed graft function were also not significantly different for the HCV+ and HCV- kidney recipients, at 12% and 8%, respectively. The percentage of patients with de novo donor specific antibodies (DSAs) was 31% and 20% (p=0.3). Rates of cellular rejection (6% vs. 7%) and antibody-mediated rejection (7% vs. 10%) were also similar.

All but one patient who received an HCV+ kidney developed transient viremia. By week 12, all patients had negative HCV RNA levels and had achieved sustained viral response or had been cured.

"Even after one year, the experience of transplanting hepatitis C-infected kidneys to uninfected recipients is good, it looks safe, with an excellent graft function," Dr. Molnar said. "These are really very-good-quality kidneys, and we shouldn't discard them, we should use them."

Dr. Molnar's center is collaborating with Massachusetts General Hospital in Boston, Vanderbilt University in Nashville, and the University of Pennsylvania in Philadelphia to collect data on transplants from HCV+ donors, he added. "The next step is basically a multicenter study."

Recipients in the study were able to start DAA treatment about 10 weeks after transplant, and third-party insurers approved the medications in all cases. Currently, Dr. Molnar said, patients are able to begin DAA about four weeks after transplant. Starting DAA in recipients before transplant could be even more effective, Dr. Molnar said, and prevent them from ever developing viremia, but insurers are currently unlikely to preapprove medication in this case.

SOURCE: American Journal of Kidney Diseases, online December 14, 2020.