Purpose: Direct acting antivirals (DAAs) have revolutionized the treatment of hepatitis C (HCV) in both general and liver transplant populations. However, data in kidney transplant (KTx) recipients is more limited, especially in those who received a HCV+ donor kidney.

Methods: We performed a retrospective review of 43 HCV+ Ktx patients treated with DAAs at our institution since January 2014.

Results: Patients were predominately black (58%) and male (79%). Over half (51%) had failed prior interferon based therapy and 25% had a prior liver transplant; 41% received a HCV+ donor kidney. Thymoglobulin induction was given in 47% of patients. DAA therapy consisted of ledipasvir-sofosbuvir (n=26) in most patients but sofosbuvir-simeprevir was also common (n=12); the median time after transplant to treatment was 1095 days (356-2265) and median time to viral clearance was 43 days (28-90). All patients achieved a sustained viral response at 12 weeks (SVR 12). The median time to transplant for recipient of HCV- donor kidney was 735 days (269-1633) while for HCV+ donor kidney was 377 days (146-783), but with a p=0.14. Use of a HCV+ donor did not affect SVR rates nor time to viral clearance (p=0.08), compared to recipients of HCV-uninfected. No significant adverse events were observed but tacrolimus dose change was required in 34% while on therapy and 33% required tacrolimus dose increases after therapy completion.

Conclusions: DAAs are safe and highly effective in curing HCV infection in HCV+ recipients of kidneys from HCV+ donors. This finding strongly supports continued use of this practice that may shorten waiting times and dialysis duration for HCV+ candidates. Tacrolimus levels should be monitored closely during and after completion of therapy.

CITATION INFORMATION: Sawinski D, Bloom R, Patel N. DAAs Rapidly Clear HCV Viremia in Recipients of HCV+ Donor Kidneys. Am J Transplant. 2016;16 (suppl 3).

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