Date: Saturday, May 30, 2020
Session Name: Poster Session D: Non-Organ Specific: Viral Hepatitis
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Transplantation of hepatitis C (HCV) positive organs into HCV negative recipients raises concerns regarding potential for infections unresponsive to DAAs. In September 2018, we began HCV+ kidneys to screened HCV- patients. We now report on the clinical parameters and outcomes of the first group
*Methods: All candidates for HCV + kidneys are evaluated by a transplant hepatologist. Evaluation includes assessment of liver function as well as an elastography assessment of liver fibrosis. Post transplant, weekly liver profiles are drawn, HCV PCR and genotype checked approximately 1 month post-transplant; DAA treatment initiated per hepatologist. Categorical variables were analyzed using Chi-Square or Fischer’s exact test; continuous variables were analyzed using Student’s T test (SPSS version 24). Significance was set at p<0.05
*Results: A total of 48 single organ kidney recipients were analyzed; 20 received HCV+ kidneys(20Ab+, 19PCR+), 28 received HCV- kidneys. Demographics and mean cold ischemia times were similar. Baseline liver function tests were similar and within normal limits. Elastography results were acceptable (F0=11, F1=8, F2=1). HCV genotypes; 1a=11;1b=2; 2a/c=2; 3=4. Liver functions test were slightly elevated at 3 months in recipients of HCV+ kidneys but were not at 6 months (table 1) or 1 year , only 3 completed 1 year as of this writing). DAA treatment = 9 Harvoni, 9 Mavyret, 1 Epclusa. One patient has had no viral load to date. Mean HCV viral load at treatment initiation = 6,509, 937 (range = 47,500 to 19,200,000). All patients had negative viral loads at end of treatment and remain negative to date.
*Conclusions: 1. No negative effects of transplantation with HCV+ kidneys were identified in this cohort to date. 2. All patients cleared HCV within 3 months after treatment. 3. Slight elevations in LFTs noted at 3 months post transplant, but return to normal at 6 months. 4. Renal function is better in HCV+ group. 5. Response rate may reflect acute rather than chronic infection. 6. Longer follow-up needed to ensure SVR is maintained, but HCV+ kidneys appear to be a viable option for appropriately screened renal transplant candidates.
|Time, Donor HCV||Creatinine||T. Bili||AST||ALT||Alk Phos||Plts|
|3 mos Neg||1.6||0.5||25||33||151||197|
|3 mos Pos||1.3||1.5||56||88||149||172|
|6 mos Neg||1.9||0.7||20||26||139||182|
|6 mos Pos||1.2||0.7||18||24||132||152|
To cite this abstract in AMA style:Meade S, Simpson MA, Walshe ED, Akoad ME, Gordon FD. The Clinical Impact of HCV D+/r- Kidney Transplantation [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/the-clinical-impact-of-hcv-d-r-kidney-transplantation/. Accessed September 28, 2020.
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