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Use of HCV+ Donors Does Not Affect HCV Clearance With Directly Acting Antiviral Therapy But Shortens the Wait Time to Kidney Transplantation

Sawinski, Deirdre MD1; Patel, Nikunjkumar MD1; Appolo, Brenda PA-C, MHS2; Bloom, Roy MD1

doi: 10.1097/TP.0000000000001410
Reviews

Background: Hepatitis C virus (HCV) infection is prevalent in the renal transplant population but direct acting antiviral agents (DAA) provide an effective cure of HCV infection without risk of allograft rejection.

Methods: We report our experience treating 43 renal transplant recipients with 4 different DAA regimens.

Results: One hundred percent achieved a sustained viral response by 12 weeks after therapy, and DAA regimens were well tolerated. Recipients transplanted with a HCV+ donor responded equally well to DAA therapy those transplanted with a kidney from an HCV− donor, but recipients of HCV+ organs experienced significantly shorter wait times to transplantation, 485 days (interquartile range, 228-783) versus 969 days (interquartile range, 452-2008; P = 0.02).

Conclusions: On this basis, we advocate for a strategy of early posttransplant HCV eradication to facilitate use of HCV+ organs whenever possible. Additional studies are needed to identify the optimal DAA regimen for kidney transplant recipients, accounting for efficacy, timing relative to transplant, posttransplant clinical outcomes, and cost.

This small cohort study confirms the efficacy and tolerability of direct-acting antiviral agents for the treatment of Hepatitis C infection early after kidney transplantation, even in recipients of kidneys from Hepatitis C positive donors.

1 Renal Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia PA.

2 Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, PA.

Received 2 March 2016. Revision received 9 June 2016.

Accepted 28 June 2016.

The authors declare no funding or conflicts of interest.

D.S. participated in research design, writing of the article, performance of the research, data analysis. N.P. participated in the performance of the research. B.A. participated in treatment of the patients. R.D.B. participated in research design and writing of the article.

Correspondence: Deirdre Sawinski, MD, 3400 Spruce Street, Philadelphia, PA 19104. (deirdre.sawinski@uphs.upenn.edu).

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