*Purpose: The efficacy of direct acting antivirals (DAAs) in HCV has cleared the path for the use of HCV positive donor kidneys into negative recipients. There is limited data, however, in this population regarding transplant-related outcomes and optimal induction immunosuppression. The purpose of this study is to assess the efficacy and safety of HCV (+) donor kidney transplantation in HCV (-) recipients.

*Methods: This is a single-center, retrospective cohort study comparing outcomes of adult HCV (-) kidney recipients who received HCV (+) vs (-) donor organs from November 2018 to July 2019. Recipients who were HCV NAT+ at time of transplant were excluded. The primary outcome was renal function at 3 months. Other outcomes included renal function at 6 months, HCV clearance after treatment, and incidence of rejection and infections. A sub-group analysis of the HCV (+) cohort compared differences in outcomes between alemtuzumab and anti-thymocyte globulin (rATG) for induction.

*Results: Sixty patients received HCV (-), 35 patients received HCV (+) kidneys, of which 26 seroconverted post-transplant. At month 1, eGFR was significantly higher in the HCV (+) group. This difference was maintained through the study period, although did not reach statistical significance. There was no difference in survival, rejection, or infections. Within the HCV (+) group, similar outcomes were observed between those that received alemtuzumab (n = 22) vs rATG (n = 13). The average time to HCV treatment was 52 days post-transplant, and all patients received DAA therapy. Majority of patients achieved SVR at 4 weeks.

*Conclusions: Our results show that kidney transplantation from HCV (+) donors into negative recipients is practical. Utilization of these organs as standard of care among transplant centers can expand the donor pool, thus increasing the number of organs available. We were able to successfully obtain DAA medications in a timely manner for all patients. Further analysis of outcomes beyond 6 months will show the long-term effects of HCV (+) donor organs over time. Use of alemtuzumab and rATG in the HCV (+) group resulted in satisfactory outcomes, highlighting that both agents can be utilized for induction in this patient population.

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