Kidney Week

Abstract: SA-PO1129

Outcomes After a Four-Week Course of Sofosbuvir/Velpatasvir Therapy in Hepatitis C Virus (HCV)-Seronegative Recipients of Kidneys from HCV-Viremic Deceased Donors

Session Information

• Transplantation: Clinical - Infectious Diseases
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Kummangal, Basheer Ahamad, Oregon Health & Science University, Portland, Oregon, United States

Basheer Ahamad Kummangal, MD, FASN

• Hack, Madelaine, Oregon Health & Science University, Portland, Oregon, United States

Madelaine Hack, MD

• Selvam, Sri Abirami, Oregon Health & Science University, Portland, Oregon, United States

Sri Abirami Selvam, MD

• Connelly, Christopher Robert, Oregon Health & Science University, Portland, Oregon, United States

Christopher Robert Connelly, MD

• Smith, Justin R., Oregon Health & Science University, Portland, Oregon, United States

Justin R. Smith, MD

• Pandav, Jay, Oregon Health & Science University, Portland, Oregon, United States

Jay Pandav, MD

• De Mattos, Angelo M., Oregon Health & Science University, Portland, Oregon, United States

Angelo M. De Mattos, MD, MPH

• Rehman, Shehzad, Oregon Health & Science University, Portland, Oregon, United States

Shehzad Rehman, MD

Background

Transplanting kidneys from HCV viremic donors to HCV seronegative recipients expands the donor pool, but optimal direct acting antiviral (DAA) duration remains undefined. Standard regimens are 8-12 weeks, but shorter courses may reduce cost and toxicity.

Methods

We performed a retrospective review of all HCV seronegative recipients that received HCV Nucleic Acid Test (NAT) positive deceased donor kidneys at the Portland VA Medical Center between 09/01/2017 and 03/01/2025 and were treated with a 4-week course of sofosbuvir/velpatasvir (SOF/VEL) initiated immediately post-transplant. Patients were followed up for 1 year after the transplant. Primary outcome was Sustained Virologic Response at 12 weeks post treatment (SVR12). Other outcomes assessed were retreatment success rate, delayed graft function (DGF), eGFR at 1 year, biopsy proven acute rejection (BPAR), DAA adverse effects, BK and CMV viremia, and all-cause mortality within one year.

Results

We included 50 patients, 92% of whom were male. The mean age was 62.8 ± 10.9 years; mean KDPI was 59.8 ± 19.6. Lymphodepleting induction was used in 41/50 patients (82%). SVR12 was achieved in 44 patients after the 4-week course (44/50, 88%). Six patients (6/50, 12%) required retreatment with either 12 weeks of Sofosbuvir/Velpatasvir/Voxilaprevir (4) or extension to 12 weeks of SOF/VEL (2). Subsequently, all achieved SVR (100% overall SVR). DGF occurred in 8/50 patients (16%), while BPAR occurred in 6/50 patients (12%). Mean eGFR at 1yr was 57.7 ± 18.7 mL/min/1.73m2. One patient died within a year of transplant (1/50, 2%) due to aspiration after stroke. Two patients had transaminitis on follow up (4%), one of which was statin-related and the other due to steatosis. There were no DAA adverse effects. CMV viremia occurred in 9/50 patients (18%) and BK viremia in 8/50 patients (16%) within the first year. The initial DAA failure group was older (70.0 ± 4.9 vs 61.8 ± 11.2 years) and had more BK viremia (2/6 vs 6/44, OR: 3.17) than the success group.

Conclusion

A 4-week SOF/VEL course achieved 88% SVR 12 with all the remaining patients successfully rescued (100% overall SVR). Initial DAA failure may be associated with higher age and BK viremia indicating over-immunosuppression. Allograft function and complication rates were comparable with published series using longer DAA courses.