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Transplanting HCV-infected kidneys safe, feasible

Treating recipients of a kidney from a donor with HCV with direct-acting antiviral medications before and after transplantation is safe and prevents chronic HCV infection, according to findings published in Annals of Internal Medicine.

“Right now, most of the usable organs from donors with hepatitis C are discarded because there are very few hepatitis C-positive recipients on the waiting list,” Niraj Desai, MD, from Johns Hopkins University School of Medicine, said in a press release. “Figuring out how to use these kidneys is a way to do more transplants and save more lives.”

Desai and colleagues conducted an open-label nonrandomized trial to investigate whether using direct-acting antivirals before and after kidney transplant from donors with HCV to recipients without HCV is feasible and well-tolerated.

The researchers enrolled 10 patients aged 50 years or older without HCV who received a kidney transplant from a deceased HCV-positive donor. Immediately before transplantation, patients received a dose of Zepatier (100-mg grazoprevir/50-mg elbasvir, Merck).

Participants who received kidneys from donors with genotype 1 infection continued to take grazoprevir/elbasvir after the transplantation for 12 weeks. Recipients of kidneys from donors with genotype 2 or 3 infection took 400 mg of Sovaldi (sofosbuvir, Gilead Sciences) in addition to the combination of grazoprevir/elbasvir for 12 weeks.

Data showed that adverse events attributable to treatment were not experienced by any of the transplant recipients. After the 12 weeks of treatment, there was no evidence of HCV RNA found in any participants.

“In this era of organ shortages, it’s difficult to watch good organs get discarded,” Christine Durand, MD, coauthor of the study from Johns Hopkins University School of Medicine, said in the release. “This was a great opportunity to take a neglected public health resource and put it to good use.”

The researchers noted that if these results are confirmed in larger studies, using this method for transplantation could significantly increase organ options and decrease mortality risks. – by Alaina Tedesco

Disclosure: Durand reports receiving grants from Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Merck Sharp and Dohme Corp., GlaxoSmithKline and ViiV Healthcare, and personal fees from Bristol-Myers Squibb, Gilead Sciences and Merck Sharp and Dohme Corp. Please see study for all other authors’ relevant financial disclosures.