One-year Outcomes of a Multicenter Trial of Transplantation of Hcv Viremic Kidney Donors into Hcv Uninfected Recipients

M. Sise¹, D. Goldberg², D. Schaubel³, J. Kort⁴, R. Alloway⁵, J. Friedewald⁶, R. Fontana⁷, S. Sultan⁸, N. Desai⁹, R. Chung¹, P. Reese¹⁰

¹Mass General Hospital, Boston, MA, ²U-Miami, Miami, FL, ³U. Pennsylvania, Philadelphia, PA, ⁴Abbvie, Chicago, IL, ⁵U Cincinnati, Cincinnati, OH, ⁶Northwestern U., Evanston, IL, ⁷U. Michigan, Ann Arbor, MI, ⁸Cornell, New York City, NY, ⁹Johns Hopkins, Baltimore, MD, ¹⁰U. Pennslyvania, Philadelpha, PA

Meeting: 2021 American Transplant Congress

Abstract number: LB 12

Keywords: Donors, marginal, Hepatitis C, Kidney

Topic: Clinical Science » Infectious Disease » Non-Organ Specific: Viral Hepatitis

Session Information

Session Name: Late Breaking: Basic & ID

Session Type: Rapid Fire Oral Abstract

Date: Monday, June 7, 2021

Session Time: 6:00pm-7:00pm

Presentation Time: 6:15pm-6:20pm

Location: Virtual

*Purpose: As interest in transplantation of Hepatitis C virus (HCV)-viremic kidneys into HCV-uninfected (HCV⁺ to HCV^– KT) recipients increases, understanding clinical outcomes beyond HCV clearance with direct-acting antivirals is important. We report the one-year outcomes of the seven-center MYTHIC (Multi-center studY to Transplant Hepatitis-C InfeCted Kidneys) trial.

*Methods: Donors were HCV RNA positive, had any HCV genotype, with KDPI < 85. The 30 KT recipients were treated with Glecaprevir-pibrentasvir (G/P) for 8 weeks, starting 2-5 days post-KT. We assessed the following 1 year post transplant: HCV virologic status, Cytomegaloviurs (CMV), and polyoma virus (BK) infection, transplant rejection, graft function, and patient survival. We performed a comparison of time-to-transplant with recipients of non-HCV infected kidneys derived from UNOS and matched based on a multivariate risk score.

*Results: Seventy-six patients were consented for evaluation, 12 were excluded, and of 64 eligible patients, 30 underwent kidney transplant from HCV-viremic donors after a median of 6.3 weeks (IQR, 1.9-10.1). Patients enrolled in the MYTHIC trial were significantly more likely to receive a kidney transplant compared to risk-score matched UNOS comparators (N=642) (Figure). All 30 participants achieved durable HCV clearance and no patient developed clinically significant liver disease. There were 9 cases of detectable CMV viremia in the first year post-transplant, with 4 cases having > 1000 IU/mL. There were 4 cases of BK viremia > 1000 IU/mL. One year survival was 93%; there were two deaths after HCV cure (Staph aureus bacteremia and unexplained death at home). There were 3 cases of biopsy-confirmed acute rejection. One year graft function among the 28 surviving patients was excellent (mean serum creatinine 1.27mg/dL, SD 0.41).

*Conclusions: One year findings from the first multicenter standardized trial of pre-emptive G/P after HCV+ to HCV- KT demonstrate that this approach is highly effective, with excellent patient outcomes and shortened waitlist time to transplant.

To cite this abstract in AMA style:

Sise M, Goldberg D, Schaubel D, Kort J, Alloway R, Friedewald J, Fontana R, Sultan S, Desai N, Chung R, Reese P. One-year Outcomes of a Multicenter Trial of Transplantation of Hcv Viremic Kidney Donors into Hcv Uninfected Recipients [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/one-year-outcomes-of-a-multicenter-trial-of-transplantation-of-hcv-viremic-kidney-donors-into-hcv-uninfected-recipients/. Accessed May 11, 2025.

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