Session Name: Non-Organ Specific: Viral Hepatitis
Session Date & Time: None. Available on demand.
*Purpose: Transplantation of Hepatitis C positive organs into Hepatitis C naïve recipients is rapidly gaining widespread acceptance. We report our experience with transplanting HCV D+/R- kidneys at our institution as a standard of care.
*Methods: Prospective kidney/SPK transplant recipients were approached at time of listing for Hepatitis C positive ( Ab+/NAT – or Ab+/NAT +) kidney offers. Post-operative outcomes were assessed including Hepatitis C related outcomes and graft/patient outcomes.
*Results: 50 patients received kidney transplants, 2 received SPK transplants. Out of the 52 patients, 10 organs were Ab+/NAT- while 42 were Ab+/NAT+. There was no seroconversion in the Ab+/NAT- cohort, and 100% seroconversion at 1 week in NAT+ cohort.Genotypes- 1A/1B/2/3 – 22/3/2/15 respectively. 6 patients received Ledipasvir/Sofobuvir, 16 patients Glecaprevir/Pibrentasvir, and 20 received Velpatasvir/Sofobuvir based on our institutional protocol.Therapy was initiated after a mean of 34 days post-transplant. Patient insurance was billed for DAA therapy with 100% approval. At end of treatment, 2/35 patients who have completed therapy continued to be PCR positive. Out of them, one patient had very low viral load which was undetectable on subsequent checks and achieved SVR. The other patient had negative PCR at 4 weeks of treatment but had subsequent treatment failure. He has started Velpatasvir/Voxilaprevir therapy with good initial response. 19 patients have achieved SVR thus far.Average donor KDPI was 62%, 8 (15%) donors had KDPI>85%. Average PRA for recipients was 16%. 13 (25%) patients had DGF. 7 (13%) patients developed acute rejection. 11 (21%) patients developed BK viremia, 7 developed BK nephropathy. 10 patients (19%) had a creatinine >2 at 4 weeks post-tx. There was no fibrosing cholestatic hepatitis C/ post-tx mortality.
*Conclusions: Hepatitis C positive to naïve transplants can be done as a standard of care with good post-transplant outcomes. Early initiation of therapy is important. We found a higher incidence of BK viremia in these patients compared to standard. This has been reported by other groups and needs further research for better understanding.
To cite this abstract in AMA style:Yadav K, Padiyar A, Zhao K, Rabets J, Jittirat A, Sclair S. Transplantation of Hepatitis C Positive Kidney and Pancreas Allografts Into Hepatitis C Naïve Recipients – A Single Center Experience as a Standard of Care [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/transplantation-of-hepatitis-c-positive-kidney-and-pancreas-allografts-into-hepatitis-c-naive-recipients-a-single-center-experience-as-a-standard-of-care/. Accessed June 12, 2021.
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