Date: Tuesday, June 4, 2019
Session Name: Poster Session D: Non-Organ Specific: Viral Hepatitis
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
- CMV-Specific CD4+ T Cells in CMV-IgG-Seronegative Individuals Protect from CMV Viremia Following Transplantation with a CMV-Seropositive Donor Kidney.
- Reducing HIV / HCV Infection Transmission from Organ Transplantation through Nucleic Acid Testing of All Potential Deceased Donors: A Cost-Effectiveness Analysis
*Purpose: Grafts from hepatitis C virus (HCV)-seropositive donors can now be considered for liver transplant (LT) due to the advent of direct-acting antiviral agents (DAA). We report our multicenter experience evaluating the use of HCV-seropositive donors to HCV-seronegative recipients LT.
*Methods: This is a retrospective analysis of prospectively collected database of an ongoing multicenter IRB-approved research study expanded into clinical protocol to evaluate adult HCV-seronegative LT recipients who received grafts from HCV-seropositive donors.
*Results: Since January 2018, 10 HCV-seronegative LT recipients received grafts from HCV-seropositive brain-dead donors [3 with negative nucleic acid testing (NAT) and 7 with positive NAT] with the median allocated MELD-Na score of 20. Two underwent simultaneous liver-kidney transplant (SLK), 2 repeat LT and 1 with SLT/repeat LT. The median waiting times were 266 days (range: 0-988) prior to listing for HCV-seropositive donor and 57 days (range: 9-238) to LT after listing for HCV-seropositive donor. No recipient of an HCV-NAT negative graft developed HCV viremia with median post LT follow-up of 48 days. All 7 patients who received HCV-NAT positive grafts had HCV viremia confirmed within 5 days after LT with the median peak HCV RNA of 33.1 million IU/mL (range 1-97.5 million). DAA treatment was started at the median time of 32 days (range 6-62) after LT: glecaprevir/pibrentasvir (G/P) for 12 weeks (5 patients), ledipasvir/sofosbuvir (LDV/SOF) + ribavirin (RBV) for 12 weeks (1 patient), and 1 patient is waiting for insurance approval. All were HCV RNA undetectable by week 4. Mild AST/ALT elevation was observed, but not associated with graft dysfunction. Acute cellular rejection was biopsy diagnosed in 3 patients, acute membranous nephropathy due to HCV infection in one patient. All were NAT positive primary LT patients. No graft loss or death was observed.
*Conclusions: LT using HCV-seropositive grafts to HCV-seronegative recipients resulted in acceptable short-term outcomes in our multicenter experience. This preliminary data supports continued use of HCV-seropositive grafts with expansion to SLK or repeat LT. Careful ongoing assessment regarding complications and timing of treatment is required.
To cite this abstract in AMA style:Wijarnpreecha K, Aqel B, Pungpapong S, Taner C, Reddy K, Leise M, Dickson R. Multicenter Experience Evaluating Outcomes of HCV-Seropositive Donors to HCV-Seronegative Recipients Liver Transplantation [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/multicenter-experience-evaluating-outcomes-of-hcv-seropositive-donors-to-hcv-seronegative-recipients-liver-transplantation/. Accessed November 15, 2019.
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