Abstract: FR-OR087
Comparison of Outcomes after DAA Therapy among HCV Infected Kidney Transplant Recipients Who Received Grafts from Either HCV Positive or Negative Donors
Session Information
- Rejection or Infection: Walking the Fine Line
November 03, 2017 | Location: Room 394, Morial Convention Center
Abstract Time: 06:18 PM - 06:30 PM
Category: Transplantation
- 1702 Transplantation: Clinical and Translational
Authors
- Sedki, Mai, University of Miami/Jackson Memorial Hospital, Miami, Florida, United States
- Cortesi, Camilo, University of Miami/Jackson Memorial Hospital, Miami, Florida, United States
- Martin, Paul, University of Miami , Miami, Florida, United States
- Roth, David, University of Miami Miller School of Medicine, Miami, Florida, United States
- Bhamidimarri, Kalyan Ram, University of Maimi, Miami, Florida, United States
Background
Direct acting antivirals (DAA) have transformed hepatitis C virus (HCV) treatment. In the kidney transplant (KT) setting, HCV-infected patients (R+) can now receive deceased donor KT (DDKT) from HCV positive donors (D+) and undergo treatment in the post-transplant period. However, a few cases of rejection have been reported in this HCV D+R+ cohort. We sought to compare outcomes among R+ receiving grafts from HCV negative donors (D-) versus D+.
Methods
This is a case series of 39 KT recipients of which 14 R+ have been transplanted with a kidney from D- and the rest from D+. All patients completed a full course of DAA. Time to transplantation, efficacy of DAA therapy, rejection episodes, tacrolimus dose adjustments, and renal function were assessed in both groups.
Results
The average age of our cohort was 56.7±8.8 and 59.1±10.5 years with 64% and 77% male in D-R+ and D+R+, respectively. In both groups the predominant genotype was 1A. The median METAVIR fibrosis stage was 2.0 in D-R+ and 1.0 in D+R+. The SVR at 12 weeks was 100% in D-R+ and 96% in D+R+. The median waiting time to transplantation was 802 days for D-R+ and 58 days in D+R+. Additionally, the median time between transplantation and start of DAA therapy was 405 days and 124 days in D-R+ and D+R+, respectively. There were 4 antibody mediated rejection episodes in D+R+ and 1 mixed rejection in D-R+. Tacrolimus dose adjustments were required in 64% of D-R+ and 52% of D+R+. When comparing kidney function before and after treatment with DAA, 42% of D-R+ and 28% of D+R+ had a significant change, defined as a change in creatinine by ≥ 0.3mg/dL.
Conclusion
Acceptance of a D+ kidney resulted in a significant decrease in transplant waiting time in R+ candidates without marked compromise. The response to DAA therapy was excellent and the SVR rates were similar to those reported in the general population. In both groups, tacrolimus dose adjustments were necessary. Our data suggests that KT recipients should be closely monitored during and immediately following HCV therapy with DAAs.
| D-R+ | D+R+ | |
| Age (years) mean ± SE Gender (%) Genotype (1, 2, 3) | 57.6 ± 8.8 64% male, 36% female 83%, 7%, 0% | 59.1 ± 10.5 77% male, 23% female 92%, 4%, 4% |
| SVR12 (%) Time to DDKT (days) median Time from DDKT to start DAA (days) median Rejection Episodes (%) | 100% 806 405 7% | 96% 58 124 16% |
| Tacrolimus Dose Changes (%) | 43% increase 22% decrease 26% no change | 48% increase 28% decrease 4% no change |
| Changes in Creatinine (%) (defined as change ≥ 0.3mg/dL) | 21% increase 21% decrease 58% no change | 20% increase 8% decrease 72% no change |