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

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