*Purpose: To mitigate the current organ shortage and underutilization of hepatitis C-infected deceased donor (HCV D+) organs, we evaluated the use of HCV D+ kidneys in HCV-uninfected recipients (HCV R-) with short-course direct-acting antiviral (DAA) prophylaxis in a pilot trial (NCT03627299).

*Methods: HCV-negative kidney transplant candidates ≥ 40 years old without liver disease were eligible. HCV D+ were ≤ 55 years old with a reactive HCV nucleic acid test, and terminal creatinine ≤ 3.5 mg/dL. Donor HCV genotype testing was done in parallel with transplant with any genotype allowed. DAA prophylaxis included one dose of glecaprevir/pibrenstavir pre-transplant and daily dosing for 4 weeks post-transplant. Recipient HCV RNA was measured frequently post-transplant (on treatment: day 1, 4, 7, week 2, 4; off treatment, week 1, 2, 4, 8, 12).

*Results: Since 10/2018, we have done 3 HCV D+/R- kidney transplants (10 planned). All donors were white, median age 34, median KDPI 60, with drug overdose as cause of death (Table 1). Donor HCV RNA range was 46,100-1.69 X 10⁶ IU/mL with genotypes 1a (n=2) and 1b (n=1). Recipients had no adverse events related to DAAs. Two recipients had no detectable viremia post-transplant; one HCV detected (non-quantifiable) on day 1 and 4 (Table 2). Two recipients have completed prophylaxis with HCV undetected at weeks 1 and 2 off treatment. There were no graft failures.

*Conclusions: Early results of this pilot study show short-course DAA prophylaxis with HCV D+/R+ kidney transplant is well-tolerated with no HCV infections to date.

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