Antiviral Therapy for Donor-Derived Hepatitis C Virus Infection after Solid Organ Transplantation

A. Kwong,¹ A. Wall,² M. Melcher,² U. Wang,³ A. Ahmed,¹ K. Khush,³ A. Subramanian,³ J. Tan,³ P. Kwo.¹

¹Gastroenterology and Hepatology, Stanford University, Palo Alto, CA
²Surgery, Stanford University, Palo Alto, CA
³Stanford University, Palo Alto, CA.

Meeting: 2018 American Transplant Congress

Abstract number: 570

Keywords: Donors, Graft acceptance, Hepatitis C, unrelated, Viral therapy

Session Information

Session Name: Concurrent Session: New Frontiers in HIV and Hepatitis

Session Type: Concurrent Session

Date: Tuesday, June 5, 2018

Session Time: 4:30pm-6:00pm

Presentation Time: 5:42pm-5:54pm

Location: Room 4C-3

Background: In the context of organ shortage, the opioid epidemic, and the advent of effective direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV), more HCV-infected donor organs are being used for transplantation. Data regarding outcomes after donor-derived HCV infection are limited. Methods: Clinical data for adult solid organ transplant recipients with donor-derived HCV infection at our institution were extracted from OPTN and the medical record. Prior to transplantation, patients consented to receiving an organ from a PHS increased-risk donor with HCV infection. HCV viral load was monitored closely post-transplant. Results: Ten recipients received organs from HCV-infected donors, including 8 liver and 2 heart transplant recipients.

Organ	MELD	Allocation MELD	Donor genotype	Days – transplant to treatment
Liver	40	40	1A	63
	11	31	3	84
	19	33	1A	38
	10	31	3	47
	15	31	3	75
	18	34	1A	48
	7	31	3	30
	31	31	1B	62
Heart			1A	11
Heart			1A	17

Six (60%) patients had a prior diagnosis of HCV and had been successfully treated pre-transplant with DAA-based regimens. All recipients were non-viremic at the time of transplantation. At the time of organ procurement, 9 of 10 donors tested positive for HCV by nucleic acid testing (NAT); one donor was HCV antibody-positive but NAT-negative. All recipients acquired HCV infection from the infected donor and were treated post-transplant with DAA-based regimens, with a median time from transplant to treatment of 47 days (IQR 32-63). Five (50%) patients have completed antiviral therapy and have achieved sustained virologic response at 4 weeks (SVR-4). There have been no adverse events related to treatment. Conclusion: Transplantation of HCV-viremic organs into non-viremic recipients is well-tolerated and results in acceptable short-term outcomes. All patients initiated DAA-based antiviral therapy within 3 months of transplantation, and all who have completed therapy have achieved SVR-4. In the face of ongoing organ shortage, such strategies may be used to expand the donor pool across organs.

CITATION INFORMATION: Kwong A., Wall A., Melcher M., Wang U., Ahmed A., Khush K., Subramanian A., Tan J., Kwo P. Antiviral Therapy for Donor-Derived Hepatitis C Virus Infection after Solid Organ Transplantation Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Kwong A, Wall A, Melcher M, Wang U, Ahmed A, Khush K, Subramanian A, Tan J, Kwo P. Antiviral Therapy for Donor-Derived Hepatitis C Virus Infection after Solid Organ Transplantation [abstract]. https://atcmeetingabstracts.com/abstract/antiviral-therapy-for-donor-derived-hepatitis-c-virus-infection-after-solid-organ-transplantation/. Accessed November 21, 2024.

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