Utilization of hepatitis C virus-positive donors in kidney transplantation.

Aneesha Shetty, Venkatesh K Ariyamuthu, Ahmet B Gungor, Bekir Tanriover

Current opinion in organ transplantation 2023 Feb 01

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Direct-acting antivirals (DAA) have transformed kidney transplantation by increasing the donor pool from hepatitis C virus (HCV)-infected donors and allowing HCV nucleic acid amplification testing (NAT) donor-positive/recipient-negative (D+/R-) transplantation over the last 7 years. Willingness to accept kidneys from HCV-infected donors and timing/duration of DAA therapy have been evolving. By 2021, most of the HCV NAT+ kidneys (92.6%) were transplanted to HCV-naive recipients. Despite the availability of effective DAA therapy, the discard rate of HCV NAT kidneys has been stagnant around 25%. The proportion of wait-listed patients willing to accept a deceased donor kidney from HCV Ab+ and HCV NAT+ donors increased 20-fold between 2015 and 2022. Wait-listed time to receive HCV NAT+ kidneys has been rising and most of the kidneys are transplanted to HCV-naive recipients. The proportion of deceased donor kidney transplants performed in recipients with HCV seropositivity decreased from 5.1 to 2.8% during the same period. Relatively short courses of DAA therapy (7-8 days) appear to be effective to decrease HCV transmission (<5%) and achieve sustained virological response at 12 weeks if administered prior to revascularization. Further studies are needed to evaluate long-term outcomes of HCV NAT D+/R- transplantation and the best course of DAA treatment. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Citation

Aneesha Shetty, Venkatesh K Ariyamuthu, Ahmet B Gungor, Bekir Tanriover. Utilization of hepatitis C virus-positive donors in kidney transplantation. Current opinion in organ transplantation. 2023 Feb 01;28(1):22-28