Experience With Hepatitis C Donor to Hepatitis C Recipient Renal Transplantation at an Academic Medical Center

Abstract

Introduction: Due to high demand for organ donation for renal transplantation, expanding the pool of potential donors is of major importance. Because of an increasing number of treatment options for hepatitis C (HCV) infection, individuals with chronic HCV have been identified as a group that could be considered for organ donation. Risk of graft loss and liver-related mortality have been shown to increase in kidney transplant patients with active HCV, but the arrival of highly effective HCV treatments offers considerable hope. Previous studies have suggested similar short-term patient and graft survival among HCV-positive recipients who receive an HCV-positive kidney compared with an HCV-negative kidney. The purpose of this study was to evaluate the outcomes of patients at our institution with chronic HCV infection who received a kidney from hepatitis C antibody positive donors. Methods: Six adult patients with end stage renal disease and chronic HCV infection underwent renal transplantation at Westchester Medical Center from HCV positive donors from January 2016 to February 2017. Data on patient age, gender, HCV genotype, fibrosis stage, HCV treatment regimen, achievement of sustained virologic response (SVR) and graft survival were collected. Results: Five patients were male and one was female. Ages ranged from 54 to 72. Fibrosis stage data by liver biopsy METAVIR score or FibroTest® was available for three patients; one had F0-1, one had F1-2 and one had F2-3 disease. Four patients had genotype 1a infection, one had genotype 1b and one had genotype 4. None of the patients experienced a change in HCV genotype post-transplant. All patients were started on direct acting antiviral therapy after transplantation (five received sofosbuvir/ledipasvir and the patient with genotype 4 infection received sofosbuvir/velpatasvir). Four patients achieved SVR at 24 weeks, while the other two patients are too early for SVR data. All patients have functioning kidney allografts. Conclusion: This study shows that transplantation of HCV positive donor kidneys to HCV viremic recipients was well tolerated in a cohort of patients at our institution. Once transplanted, these patients have access to an increased number direct acting antivirals and can usually achieve SVR. Extending donor criteria to include hepatitis C antibody positive patients can decrease the wait time for individuals on the renal transplant list, and should be considered in selected patients after obtaining informed consent.