*Purpose: Transplantation of hepatitis C (HCV) positive organs into HCV negative recipients raises concerns regarding potential for infections unresponsive to DAAs. In September 2018, we began HCV+ kidneys to screened HCV- patients. We now report on the clinical parameters and outcomes of the first group

*Methods: All candidates for HCV + kidneys are evaluated by a transplant hepatologist. Evaluation includes assessment of liver function as well as an elastography assessment of liver fibrosis. Post transplant, weekly liver profiles are drawn, HCV PCR and genotype checked approximately 1 month post-transplant; DAA treatment initiated per hepatologist. Categorical variables were analyzed using Chi-Square or Fischer’s exact test; continuous variables were analyzed using Student’s T test (SPSS version 24). Significance was set at p<0.05

*Results: A total of 48 single organ kidney recipients were analyzed; 20 received HCV+ kidneys(20Ab+, 19PCR+), 28 received HCV- kidneys. Demographics and mean cold ischemia times were similar. Baseline liver function tests were similar and within normal limits. Elastography results were acceptable (F0=11, F1=8, F2=1). HCV genotypes; 1a=11;1b=2; 2a/c=2; 3=4. Liver functions test were slightly elevated at 3 months in recipients of HCV+ kidneys but were not at 6 months (table 1) or 1 year , only 3 completed 1 year as of this writing). DAA treatment = 9 Harvoni, 9 Mavyret, 1 Epclusa. One patient has had no viral load to date. Mean HCV viral load at treatment initiation = 6,509, 937 (range = 47,500 to 19,200,000). All patients had negative viral loads at end of treatment and remain negative to date.

*Conclusions: 1. No negative effects of transplantation with HCV+ kidneys were identified in this cohort to date. 2. All patients cleared HCV within 3 months after treatment. 3. Slight elevations in LFTs noted at 3 months post transplant, but return to normal at 6 months. 4. Renal function is better in HCV+ group. 5. Response rate may reflect acute rather than chronic infection. 6. Longer follow-up needed to ensure SVR is maintained, but HCV+ kidneys appear to be a viable option for appropriately screened renal transplant candidates.

« Back to 2020 American Transplant Congress