Session Name: Concurrent Session: Non-Organ Specific: Viral Hepatitis
Date: Tuesday, June 4, 2019
Session Time: 4:30pm-6:00pm
Presentation Time: 5:30pm-5:42pm
Location: Room 309
*Purpose: Direct acting antivirals (DAAs) have led to high cure rates (>95%) for hepatitis C. Utilization of HCV+ donor kidneys for patients with advanced kidney disease can expand the donor pool and reduce the excess discard rates for such kidneys. Our single center open label pilot study had used DAAs as pre and post exposure prophylaxis for HCV D+/R- transplantation with excellent results, and prevented chronic HCV infection in all recipients. This study looked at the two year renal outcomes for our study patients.
*Methods: All HCV D+/R- patients who had been enrolled in our pilot study between 08/2016 to 02/2017 were identified for retrospective analysis. Each had received a single dose of grazoprevir/elbasvir (GZR-EBR) pre-transplant and daily for 12 weeks post-transplant with no detectable virus at the end of treatment. The patients were serially followed from the time of transplant to 11/2018 for a two year period. End points were patient and graft outcomes.
*Results: 10 HCV D+/R- patients were analyzed. Donors had detectable HCV plasma RNA, were < 50 years, and had serum creatinine < 3 mg/dl. Median KDPI was 45 (range 34-62) and cold ischemia time 29 hours (range 18-36). There were 8 male and 2 female recipient patients. 8 out of 10 were white. Median age 71 (range 57-76). All received induction with rabbit antithymocyte globulin with a median dose of 5.35 (range 4.4-6.3) mg/kg and maintenance immunosuppression consisting of mycophenolate mofetil, tacrolimus and prednisone at discharge. Four recipients had delayed graft function (DGF) but all were off dialysis before they left the hospital. Median creatinine and GFR at 1 year were 1 mg/dl and 60 ml/min/1.73 m2 respectively. Similarly, median creatinine at 2 years is 1.05 mg/dl, median GFR 63 ml/min/1.73 m2 and median urine protein to creatinine ratio 0.1 (see fig1). There have been no episodes of rejection or graft loss. Infectious complications to date include norovirus enteritis in 1 recipient, legionella pneumonia in 1 recipient and three cases of CMV viremia and three of BK viremia, all effectively treated.
*Conclusions: This study shows excellent patient and graft outcomes in HCV- recipients of HCV+ donor kidneys. Renal outcomes two years out utilizing this novel strategy are excellent without any unanticipated adverse consequences. It remains to be seen if outcomes are comparable long term.Fig 1
|Creatinine mg/dl 1 yr||2||0.8||1.3||1.1||1.1||1.2||0.7||1||1||0.9|
|GFR ml/min 1 yr||32||73||58||60||63||59||>60||92||70||>60|
|Creatinine mg/dl 2 yr||1.9||1.3||1.1||1||1.2||1.1||0.7||1||1||0.9|
|GFR ml/min 2 yr||34||41||65||81||60||61||>60||94||74||88|
|Proteinuria (p/c) 2 yr||0.08||0.3||0.4||0.1||0.08||0.1||0.07||0.1||0.1||0.3|
To cite this abstract in AMA style:Thaduri S, Durand C, Desai N, Segev D, Bair N, Brown D, Naqvi FF. Renal Outcomes from Expander-1: Pilot Study of HCV+ Donor Kidneys for HCV- Kidney Recipients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/renal-outcomes-from-expander-1-pilot-study-of-hcv-donor-kidneys-for-hcv-kidney-recipients/. Accessed May 9, 2021.
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