Session Time: 6:00pm-7:00pm
Presentation Time: 6:05pm-6:10pm
*Purpose: Trials describing 4-12 week courses of direct-acting anti-viral drugs (DAAs) to treat hepatitis C virus (HCV) transmission from infected donors to uninfected kidney transplant recipients (D+/R- transplants), may be limited in application to the ‘real-world’ by costs and delayed access to expensive DAAs. We previously reported HCV transmission of 12% among D+/R- transplants (N=52) with 2-4 day pangenotypic sofosbuvir/velpatasvir (SOF/VEL) prophylaxis. Here we report new data on HCV transmission rates with 7-day prophylaxis (N=50) and cumulative outcomes of all D+/R- transplants (N=102) performed at our center so far.
*Methods: Eligible D+/R- transplant recipients received escalating duration SOF/VEL over treatment groups (Group 1: 2 or 4 days; Group 2: 7 days) with first dose immediately pre-transplant. The primary outcome was the rate of HCV transmission from donor to recipient defined as a positive qNAT at 90 days post-transplant. Secondary outcomes included sustained virologic response at 12 weeks (SVR-12) after completion of HCV therapy, adverse events related to HCV infection and therapy, and allograft function compared with a contemporary matched cohort of HCV D-/R- transplants
*Results: A total of 102 D+/R- transplants (mean age=52) were performed. Nine patients (9/102; 9%; 95%CI: 5%-16%) met the primary outcome of the development of HCV transmission by 90 days post-transplant with a three-fold decline across the two groups: Group 1 (7/52; 13%; 95%CI: 5%-25%) vs Group 2 (2/50; 4%; 95%CI: 0%-13%). All patients with HCV transmission achieved SVR-12 post-full course therapy. There was a higher incidence of peri-operative PPI use (3/9; 33% vs 10/93; 11%; p=0.05) and re-transplant status (2/9; 22% vs 0/93; p=0.007) among those with transmission vs those that did not. A 1:1 matched analysis with contemporary HCV D-/R- transplants (controls) showed that the pre-transplant wait time was shorter for D+/R- compared with D-/R- (mean: 1.8 vs 4.4 years; p<0.001). There were no differences in infections, rejection, development of de-novo donor-specific antibody, or transplant outcomes between controls vs cases up to 6 months of transplant. At the end of 6 months follow-up, two patients each in the D-/R- group and the D+/R- lost their transplant. Similarly, two patients died in the two groups by 6 months post-follow-up. For the D+/R- group, none of the patients with graft loss or death had HCV transmission. In a linear regression model adjusted for covariates, donor HCV status was not significantly associated with estimated GFR at 3- and 6-months post-transplant.
*Conclusions: This paper describes extremely low transmission rate with a seven-day peri-operative DAA regimen. Compared with a matched HCV negative kidney transplant recipient cohort, D+/R- transplants had reduced wait times and comparable short-term kidney function outcomes.
To cite this abstract in AMA style:Gupta G, Yakubu I, Kimball P, Kang L, Mitchell K, Shinbashi M, Kumar D, Moinuddin I, Kamal L, King A, Bhati C, Levy M, Cotterell A, Sharma A, Sterling R. Outcomes of Short-Duration Anti-Viral Prophylaxis for Hepatitis C Positive Donor Kidney Transplants [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-of-short-duration-anti-viral-prophylaxis-for-hepatitis-c-positive-donor-kidney-transplants/. Accessed September 22, 2021.
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