Direct-acting antivirals prevent infection in non–HCV-infected kidney transplant recipients
Apart from being tolerable and feasible, pre- and post-transplantation hepatitis C virus (HCV) treatments prevent HCV infection in non–HCV-infected recipients (ie, HCV D+/R− transplantation) of kidneys, a recent open-label nonrandomized trial in a single centre has shown.
In total, there were 10 HCV D+/R− transplant recipients included in this study. Treatment-related adverse events did not occur in any of the participants, and HCV RNA was not detected at 12 weeks following HCV treatment.
“If confirmed in larger studies, this strategy should markedly expand organ options and reduce mortality for kidney transplant candidates without HCV infection,” the authors said.
In this trial, 10 HCV D+/R− kidney transplant candidates (aged >50 years) with no available living donors were assessed to determine the safety and efficacy of using direct-acting antivirals (DAAs) as prophylaxis before and after kidney transplantation from HCV-infected donors to non–HCV-infected recipients.
Transplanted kidneys were from deceased donors (aged 13–50 years) with positive HCV RNA and HCV antibody test results. All recipients were administered grazoprevir (GZR) 100 mg and elbasvir (EBR) 50 mg immediately prior to transplantation.
Patients receiving kidneys from donors with genotype 1 infection continued taking GZR-EBR for 12 weeks post-transplantation, and recipients of organs from donors with genotype 2 or 3 infection received sofosbuvir 400 mg added to GZR-EBR for 12 weeks of triple therapy.
The incidence of GZR–EBR treatment-related adverse events was the primary safety outcome, while the primary efficacy outcome was the proportion of recipients with an HCV RNA level below the lower limit of quantification 12 weeks after prophylaxis.
“Given the high mortality rate for patients with end-stage kidney disease receiving dialysis and the efficacy and safety of HCV treatments, discarded kidneys from HCV-infected donors may be a neglected public health resource,” according to the authors, adding that the trial was limited by its nonrandomized design and the small number of patients.