HCV Prophylaxis Could Expand Kidney Availability
In a small study, direct-acting prophylaxis against hepatitis C virus (HCV) appeared safe and well-tolerated in uninfected recipients of HCV+ kidneys.
With direct-acting antiviral prophylaxis, uninfected recipients of kidneys from hepatitis C (HCV)-positive donors appeared free of disease 1 year after transplantation, researchers reported in an online report in the Annals of Internal Medicine.
Investigators at Johns Hopkins Hospital in Baltimore tested the feasibility and tolerability of kidney transplantation from HCV-positive donors to HCV-negative recipients in 10 individuals older than 50 years. The kidneys were recovered from deceased donors aged 13–50 years who tested positive for HCV RNA and HCV antibody. HCV-positive donors tended to be young with few other co-existing illnesses.
For prophylaxis, recipients were given a dose of grazoprevir 100 mg/elbasvir 50 mg before entering the operating room. For 12 weeks after transplantation, recipients of genotype 1 donor kidneys continued the regimen, whereas recipients of genotype 2 or 3 kidneys also received sofosbuvir 400 mg.
None of the recipients experienced treatment-related adverse events. Five never had detectable plasma HCV RNA, 4 had low levels the first day after surgery, and 1 had low levels for up to a week (peak 136 IU/mL). Investigators reported no symptoms or clinical consequences. In addition, grafts appeared to function well.
“Right now, most of the usable organs from donors with hepatitis C are discarded because there are very few hepatitis C-positive recipients on the waiting list,” senior author Niraj Desai, MD, of Johns Hopkins University School of Medicine stated in a news release. “Figuring out how to use these kidneys is a way to do more transplants and save more lives.”
The authors encouraged further study of the strategy in clinical trials: “If confirmed in larger studies, this strategy should markedly expand organ options and reduce mortality for HCV-KT candidates.”
Durand CM, Bowring MG, Brown DM, et al. Kidney Transplantation from Hepatitis-C-infected Donors to HCV-uninfected Recipients with Direct-Acting Antivirals as Prophylaxis: An Open-Label Nonrandomized Trial. Ann Intern Med. [Unedited manuscript]
One year posttransplant, recipients of hepatitis C kidneys disease-free [press release]. Johns Hopkins Medicine; March 5, 2018.