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HCV Viremic Kidneys for Uninfected Recipients with DAA Treatment Offers Sustained Virologic Response

J. Torabi, A. Montal, M. Ajaimy, L. Lirano, Y. Azzi, C. Pynadath, E. Akalin, J. Melvin, M. Kinkhabwala, S. Greenstein, J. P. Rocca, J. A. Graham

Montefiore Medical Center, Bronx, NY

Meeting: 2020 American Transplant Congress

Abstract number: A-045

Keywords: Hepatitis C, Kidney transplantation

Session Information

Session Name: Poster Session A: Kidney Deceased Donor Selection

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: Development of direct acting anti-viral medications (DAA) have offered cure rates for hepatitis C infection (HCV) approaching 100%. This has provided the ability to transplant HCV positive kidneys into noninfected recipients.

*Methods: Forty HCV negative patients who received HCV NAT positive kidneys (D+/R-) were age matched to 40 HCV negative patients who received non-infected kidneys (D-/R-). Post-operative complications and graft function were compared. D+/R- patients were monitored post-operatively for development of viremia and subsequently treated with DAAs.

*Results: The D-/R- group were age matched to the D+/R- group (64.9 vs 66.9 years, p=0.02). The mean donor age was higher in the D-/R- group (43.3 vs 35.1, p=0.01). KDPI was comparable in both groups (62.9 vs 60.9, p=0.54), however removal of HCV status from the KDPI equation unmasked higher KDPI in the D-/R- group (62.9 vs 37.3, p=0.01). In the D+/R- group 100% of patients develop HCV viremia on a median of POD 2.5 [0-17]. The median initial viral load was 876 copies/uL [range:10-1.0×10^8] with a median peak viral load of 4.8×10^5 copies/uL [range:495-1.0×10^8] on median of POD 7 [range:1-27]. Median days to viral clearance occurred on POD 58. All patients achieved SVR 12 weeks. Mean LOS (7.0±3.7 vs 5.1±2.4, p=0.01) and DGF (55 vs 27.5%, p=0.01) was higher in the D-/R- group. Rates of acute rejection, graft loss and death were comparable in both groups (Table 1). GFR was lower in the D-/R- group at 1-, 3- but comparable at 6-months (Table1). All patient tolerated DAA treatment with no adverse effects from treatment.

*Conclusions: D+/R- transplantation offers patients an alternative strategy to increase access to kidney transplantation. Development of HCV viremia was consistently observed but cleared following DAA treatment.

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To cite this abstract in AMA style:

Torabi J, Montal A, Ajaimy M, Lirano L, Azzi Y, Pynadath C, Akalin E, Melvin J, Kinkhabwala M, Greenstein S, Rocca JP, Graham JA. HCV Viremic Kidneys for Uninfected Recipients with DAA Treatment Offers Sustained Virologic Response [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/hcv-viremic-kidneys-for-uninfected-recipients-with-daa-treatment-offers-sustained-virologic-response/. Accessed May 11, 2025.

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