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Kidney Week

Abstract: PO2443

Hepatitis C NAT-Positive Kidney Transplant into Hepatitis C-Negative Recipients: A Single-Center Experience

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Kaur, Taranpreet, University of Cincinnati, Cincinnati, Ohio, United States
  • Choi, Jeongwon, University of Cincinnati, Cincinnati, Ohio, United States
  • Shah, Silvi, University of Cincinnati, Cincinnati, Ohio, United States
  • Bumb, Shalini, University of Cincinnati, Cincinnati, Ohio, United States
  • Abu Jawdeh, Bassam G., University of Cincinnati, Cincinnati, Ohio, United States
  • Govil, Amit, University of Cincinnati, Cincinnati, Ohio, United States
Background

Direct-acting antivirals (DAA) for Hepatitis (Hep) C have a 96-100% sustained viral remission (SVR) rate. This makes transplant of Hep C nucleic acid amplification testing (NAT)+ kidneys and treatment post-transplant feasible. We performed a prospective IRB approved trial at our center to validate the use and challenges of this approach.

Methods

Informed consent from eligible patients was obtained. Patients with chronic liver disease, dual organ transplants, HIV and active Hep B infection were excluded. Post-transplant, viral load was tested on day 3-5 and 7-10 and weekly thereafter until viremia was confirmed. All pts. were treated by hepatologist based genotype and insurance company preference. Standard of care immunosuppression protocols was used.

Results

51 pts. got Hep C NAT+ kidney. The median age of the recipients was 58 years (range 29-72) and the mean wait time was 802 days (range 68-3073). Mean KDPI was 58.8 (range 27-94) with a median donor age of 38 years (range 21-56). Out of 16 implant biopsies, 13/16 (81%) had <5 %of sclerotic glomeruli, 14/16 (88%) had minimal interstitial fibrosis, and 15/16 (94%) had no arteriosclerosis. There was a 100 % transmission rate of Hep C. As of now, 46/51 (90%) have completed a 12-week course of DAA, and 45/46 (98%) have become RNA negative with 34/46 (74%) achieving SVR.So far, there had been no insurance denials of DAA coverage. Among 18 for cause allograft biopsies,1 showed tubuloreticular inclusion thought to be Hep C related and another showed recurrent C3GN thought to be triggered by Hep C and Hep B

Conclusion

Transplantation of HepC NAT+ kidneys to Hep C negative recipients followed by treatment with DAA is a feasible option as a standard of care outside trials. Recipients should be monitored for Hep C related complications