Optimizing Outcomes with a Collaborative Approach after Kidney Transplant in Hepatitis C-Positive Recipients Receiving Hepatitis C-Positive Grafts
Piedmont Transplant Institute, Piedmont Healthcare, Atlanta, GA.
Meeting: 2018 American Transplant Congress
Abstract number: 429
Keywords: Cadaveric organs, Hepatitis C, Kidney transplantation, Outcome
Session Information
Session Name: Concurrent Session: Kidney Deceased Donor Allocation - 2
Session Type: Concurrent Session
Date: Tuesday, June 5, 2018
Session Time: 2:30pm-4:00pm
Presentation Time: 3:30pm-3:42pm
Location: Room 6E
PURPOSE: To evaluate the multidisciplinary approach to HCV treatment in HCV+ kidney recipients receiving HCV+ grafts. METHODS: Single center review of treatment and outcomes in HCV+ kidney recipients who received HCV+ grafts. Patients were managed by the joint transplant nephrology, hepatology, and pharmacy clinic. RESULTS: 18 HCV+ patients underwent kidney transplant from HCV+ donors from 2012-2017. Most were male (89%), African-American (83%), HCV genotype 1 (89%), and HCV treatment-naïve (72%). Mean wait list time to transplant was 46 months; mean time from HCV+ organ consent to transplant was 11 months. Overall mean wait time for kidney recipients at our center is 92 months. 17/18 patients received post-transplant HCV therapy; one has not yet been treated due to ongoing wound complications. Most patients (11/17) started therapy within 30 days of their hepatology consult. Most (11/17) received ledipasvir-sofosbuvir for 12 weeks while 6/17 received other regimens based on treatment date, genotype, prior therapy, or payor issues. 12/17 have reached the SVR12 time point; 12/12 (100%) have documented SVR. Five patients have completed HCV therapy and are awaiting SVR testing; 5/5 (100%) have unquantifiable HCV at end of treatment. SVR12 data will be updated for the meeting. All patients underwent immunosuppression per center protocol with anti-thymocyte globulin/tacrolimus/mycophenolate/prednisone. There was no increased risk of death, graft loss, or rejection when compared to overall kidney transplant program data. No patients were lost to follow up. CONCLUSIONS: Using HCV+ donor organs for HCV+ kidney recipients shortens wait time to transplant while maintaining excellent patient and graft outcomes. A collaborative approach between nephrologists, hepatologists and pharmacists yields excellent post-transplant HCV treatment outcomes.
| Kidney Transplant Outcomes 2012-2017 | |||
| HCV+ recipients receiving HCV+ organs (n=18) | HCV+ recipients receiving HCV- organs (n=14) | All kidney recipients (n=816) | |
| Wait list time, months | 46 | 94 | 92 |
| 1-yr patient survival | 100% | 100% | 98.2% |
| 1-yr graft survival | 100% | 92.9% | 94.4% |
| Acute rejection rate (study period data) | 5.6% | 7.1% | 6.8% |
| Post-transplant SVR12 | 12/12* (100%) | 13/13* (100%) | NA |
| *Remaining treated patients awaiting SVR12 time point | |||
CITATION INFORMATION: Ray A., Rubin R., Ommert T., Cross R., Klein C. Optimizing Outcomes with a Collaborative Approach after Kidney Transplant in Hepatitis C-Positive Recipients Receiving Hepatitis C-Positive Grafts Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Ray A, Rubin R, Ommert T, Cross R, Klein C. Optimizing Outcomes with a Collaborative Approach after Kidney Transplant in Hepatitis C-Positive Recipients Receiving Hepatitis C-Positive Grafts [abstract]. https://atcmeetingabstracts.com/abstract/optimizing-outcomes-with-a-collaborative-approach-after-kidney-transplant-in-hepatitis-c-positive-recipients-receiving-hepatitis-c-positive-grafts/. Accessed December 3, 2024.« Back to 2018 American Transplant Congress