Date: Saturday, May 30, 2020
Session Name: Poster Session A: Non-Organ Specific: Viral Hepatitis
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
- Hepatitis C Antibody Positive (HCV Ab+)/Nucleic Acid Test Negative (NAT -) Deceased Donor Kidney Transplantation into Hepatitis C Negative (HCV -) Recipients: Is It Safe?
- Longer-Term Outcomes for Hepatitis C Virus Negative Recipients of Kidneys from Hepatitis C Virus Nucleic Acid Test Positive Donors: The THINKER Trial
*Purpose: The United States opioid use epidemic over the past decade has coincided with an increase in hepatitis C positive (HCV+) kidney donors. Our aim was to evaluate short-term outcomes in HCV- recipients receiving HCV NAT+ deceased donor kidneys versus HCV- kidneys.
*Methods: Adult HCV- patients receiving HCV NAT+ kidneys were matched to an HCV- recipient/donor cohort that was compatible on transplant period (± 10 months) and several SRTR Risk Adjustment Model characteristics (recipient age, gender, race) for survival after deceased donor kidney transplant. The HCV- matching donor pool excluded those who received previous or blood type A2 to B transplants. Outcomes were short-term (within 90 days) adverse events including delayed graft function, readmission, rejection, infection, and longitudinal graft function. Data were analyzed using summary statistics, t- and chi-square tests for between-group comparisons, and longitudinal mixed effects models.
*Results: The sample included 56 HCV- recipients (28 HCV NAT+, 28 HCV- donors; recipient age 57 ± 11 years; 50% males; 55% white, 32% black) transplanted between August 2018 and June 2019. Pre-transplant between-group characteristics did not differ for race, primary diagnosis, co-morbidities, surgical complication, whether dialyzed, KDPI, or for induction immunosuppression and pre-transplant patient-reported health-related QOL (all p≥ 0.177). HCV NAT+ donor recipients had significantly lower calculated panel reactive antibody values (11±21 vs 29±34, p=0.022) and statistically comparable, but clinically shorter wait times (29±23 vs 41±31 months, p=0.110). Patients on dialysis who opted for an HCV NAT+ kidney spent significantly shorter time on dialysis (48±21 vs 74±37 months, p=0.005). There was no effect of HCV NAT+ donor to HCV- recipient transplantation on delayed graft function (p=0.075), longitudinal renal function, or readmissions (p=1.00). Among patients who were readmitted within 90 days, total length of stay to date for all readmissions within 30 days averaged 3±5 vs 2±2 (p=0.465) and 9±7 vs 5±6 (p=0.122) for HCV NAT+ and HCV- donor recipients, respectively. HCV NAT+ donor recipients experienced a decrease in HCV RNA titers with DAA therapy.
*Conclusions: Our research demonstrates that use of HCV NAT+ donor kidneys in uninfected recipients is a potential avenue to increase rates of kidney transplantation without significant adverse outcomes in the early postoperative period. Visual inspection of longitudinal HCV titers indicates that HCV- recipients who acquire HCV can be successfully treated. Future studies should examine longer term outcomes and HCV infection characteristics including response to therapy over time in this recipient population.
To cite this abstract in AMA style:Schaefer H, Concepcion B, Sudhakar A, Rega S, Feurer I, Shawar S, Dubrey B, Shaffer D, Forbes R. Contract a Virus to Save a Life: A Comparison of Short Term Outcomes between Adult Hepatitis C Negative Kidney Transplant Recipients Receiving a Hepatitis C NAT Positive versus Hepatitis C Negative Deceased Donor Kidney [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/contract-a-virus-to-save-a-life-a-comparison-of-short-term-outcomes-between-adult-hepatitis-c-negative-kidney-transplant-recipients-receiving-a-hepatitis-c-nat-positive-versus-hepatitis-c-negative-de/. Accessed March 8, 2021.
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