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Kidney Transplantation from Hepatitis C Infected Donors to Hepatitis C Negative Recipients: Does Organs Selection Matter?

B. Rawashdeh1, L. Luu1, Z. Sahli1, E. McCracken1, A. Doyle2, K. Brayman1, A. Agarwal1

1Transplant Surgery, University of Virginia, Charlottesville, VA, 2Division of Transplant Nephrology, University of Virginia, Charlottesville, VA

Meeting: 2020 American Transplant Congress

Abstract number: A-049

Keywords: Hepatitis C, Kidney transplantation, Outcome

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: Recently, there has been a marked increase in the availability and use of kidneys from hepatitis C virus (HCV) positive deceased donors for transplantation. This study aims to evaluate the outcome, safety and feasibility of transplantation of kidneys from HCV-positive donors to HCV-negative recipients.

*Methods: A prospective single-institution review of 30 sequential kidney recipients performed between 3/2019 and 10/2019 that received organs from donors who were HCV nucleic acid test (NAT) and anti-HCV antibody positive. All recipients were HCV NAT and anti-HCV antibody negative at the time of transplant. All recipients had T cell depletion and triple immunosuppression. Data collected included donor and recipient demographics, direct antiviral agent treatment regimens, liver function, kidney graft outcome, and de novo donor-specific antibodies.

*Results: The mean recipient age was 59 ±10. 70% were male, and 50% were Caucasian. The mean waiting time on the transplant list was 1280 ± 630 days. The mean follow up time was 149 ±80 days. The mean donor age was 36 ±10, 59% were male, and 93% were Caucasian. The mean kidney donor profile index was 63 ±12. 8 (27%) were deceased after cardiac death donors. The cold ischemic time median (IQR) was 25 (18-29) hours. 28 recipients (93%) developed HCV viremia and received treatment; 17 (61%) had genotype 1a HCV. Interestingly, 2 recipients (7%) remain HCV NAT negative after transplantation. The mean time between transplantation and treatment initiation was 44 ±10 days. 18 patients (64%) received glecaprevir/pibrentasvir and 10 patients (36%) received ledipasvir/sofosbuvir. 20 patients (71%) completed direct antiviral agent therapy; of those, 3 patients (15%) had a sustained virologic response at 12 weeks (SVR12). 1 patient continued to exhibit HCV viremia after the end of treatment. 8 patients (29%) remains on treatment. 20 patients (67%) had delayed graft function. The mean estimated GFR (eGFR) at 12 weeks after transplantation (mL/min/1.73 m2) was 49 ±13, and at the end of hepatitis C treatment was 48 ±18. 5 patients (17%) had BK viremia after transplant, and 5 patients (17%) had CMV viremia. 4 patients (13%) had De novo DSA; 3 class I and 1 class II. 2 patients (7%) had mild cellular mediated rejection. All patients tolerated the hepatitis C therapy. Transaminitis occurred in 9 recipients (30%), with at least 3 times normal aminotransferase levels, no recipients had evidence of advanced hepatic dysfunction or graft loss.

*Conclusions: Kidney transplantation from HCV infected donors to HCV negative recipients should be considered in all eligible patients. However, a combination of high kidney donor profile index, HCV positive graft and elderly recipient may result in higher rate of delayed graft function .

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To cite this abstract in AMA style:

Rawashdeh B, Luu L, Sahli Z, McCracken E, Doyle A, Brayman K, Agarwal A. Kidney Transplantation from Hepatitis C Infected Donors to Hepatitis C Negative Recipients: Does Organs Selection Matter? [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/kidney-transplantation-from-hepatitis-c-infected-donors-to-hepatitis-c-negative-recipients-does-organs-selection-matter/. Accessed June 6, 2025.

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