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Kidney Week

Abstract: PO2440

Direct Acting Antiviral Prophylaxis to Prevent Virus Transmission from Hepatitis C Viremic Donors to Hepatitis C-Negative Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Yakubu, Idris, Virginia Commonwealth University Health System, Richmond, Virginia, United States
  • Sterling, Richard, Virginia Commonwealth University Health System, Richmond, Virginia, United States
  • Levy, Marlon F., Virginia Commonwealth University Health System, Richmond, Virginia, United States
  • Bhati, Chandra S., Virginia Commonwealth University Health System, Richmond, Virginia, United States
  • Kumar, Dhiren, Virginia Commonwealth University Health System, Richmond, Virginia, United States
  • Moinuddin, Irfan Ahmed, Virginia Commonwealth University Health System, Richmond, Virginia, United States
  • Kamal, Layla, Virginia Commonwealth University Health System, Richmond, Virginia, United States
  • King, Anne L., Virginia Commonwealth University Health System, Richmond, Virginia, United States
  • Sharma, Amit, Virginia Commonwealth University Health System, Richmond, Virginia, United States
  • Cotterell, Adrian, Virginia Commonwealth University Health System, Richmond, Virginia, United States
  • Gupta, Gaurav, Virginia Commonwealth University Health System, Richmond, Virginia, United States
Background

Studies have described a 12-week course of direct-acting anti-viral drugs (DAA) for HCV transmission from infected donors to negative kidney transplant recipients. This strategy is limited by high cost and access to DAA. A prophylactic strategy may be safer and cost-effective. We recently reported the results of our experience where a 2-4 day peri-operative DAA prophylaxis using sofosbuvir/velpatasvir (SOF/VEL) for D+/R- transplants prevented HCV transmission in a majority (88%) of cases. We report our entire experience based upon an adaptive iterative trial design where prophylaxis with SOF/VEL was initially extended to 7 days, and ezetimibe was added for a second cohort.

Methods

Wait listed patients were eligible if they met the following: (absence of living donor; panel reactive antibody≤50%; ≤1 prior transplant; absence of liver disease). The primary outcome was HCV transmission, defined as 2 consecutive positive HCV nucleic acid tests tested at Day 7 and 14-21 post-transplant. Confirmed HCV viremia triggered a12-week course of DAA.

Results

100 patients (mean age=56 years) received D+/R- transplants from November 2017 to April 2020. Mean wait time to transplant from enrollment was 34 days and the mean KDPI was 67%. At a median follow-up of 10 months (IQR: 1-30months), graft survival was 99% and patient survival was 98% with no cases of liver dysfunction. In Group 1, 10 patients received one dose SOF/VEL immediately pre-transplant and a second dose on post-transplant Day 1. Viral transmission was 30% [3/10]. In Group 2, 42 patients received two additional doses of SOF/VEL on Days 2 and 3 post-transplant. Viral transmission rate dropped down to 9.5% (4/42). All patients then achieved SVR with full DAA therapy in groups 1 and 2. In Group 3 (N=28), prophylaxis was extended to 7 days with further reduction in transmission to 3.5% (1/28). In group 4, 19 patients received ezetimibe and SOF/VEL for 7 days. Viral transmission was 5% (1/19).

Conclusion

A 7-day DAA prophylaxis is effective in preventing donor-derived HCV transmission, can result in significant cost-savings and increase access to transplants. Adding ezetimibe to SOF/VEL did not provide an additional benefit in preventing viral transmission.