Kidneys from hepatitis C-infected (HCV+) donors are underutilized in an era of severe organ shortage. In an effort to expand the donor pool, we evaluated the use of HCV+ deceased donor kidneys for HCV-uninfected (HCV-) recipients with pre-emptive HCV treatment in a pilot trial (NCT02781649).

Methods: HCV- kidney transplant candidates over age 50 were enrolled from 8/2016-11/2016. Eligible donors had detectable HCV plasma RNA, were < 50 years, and serum creatinine < 3 mg/dL. Recipients received a single dose of grazoprevir/elbasvir (GZR-EBR) pre-transplant and daily for 12 weeks post-transplant. Sofosbuvir was added when genotype 2 or 3 was identified in the donor. HCV RNA was measured on post-operative day (POD) 1, weekly for the first month, and every 4 weeks through 12 weeks post-treatment.

Results: To date, 8 HCV- recipient/HCV+ donor transplants have been performed. All donors were white, median age 30, 4 female and 4 died due to drug overdose. Donor HCV RNA ranged from < 15 to 4.6 x 10⁶ international units/mL. HCV genotypes were 1a (n=2), mixed 1a/3 (n=1), 3 (n=1) and insufficient HCV (n=3). No adverse events related to GZR-EBR have occurred. HCV RNA was detected in 4 recipients on POD1 but not at later timepoints; 4 recipients never had HCV RNA detected. One recipient has completed GZR-EBR with no HCV RNA detected post-treatment. No graft failure was observed; 3 recipients had delayed graft function.

Conclusion: In this pilot study, pre-emptive HCV treatment for HCV- recipients of HCV+ donors was well-tolerated with no adverse events and no HCV infection has been observed in the recipients. This strategy might safely expand donor options for kidney transplant candidates who face high waitlist mortality.

CITATION INFORMATION: Durand C, Brown D, Wesson R, Bhair N, Naqvi F, Ostrander D, Bowring M, Massie A, Rasmussen S, Sugarman J, Segev D, Sulkowski M, Desai N. EXPANDER-1: Exploring Renal Transplants Using Hepatitis-C Infected Donors for HCV-Negative Recipients. Am J Transplant. 2017;17 (suppl 3).

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