HCV-Infected Kidneys Safely Transplanted Into HCV-Negative Recipients

Miklos Molnar, MD, PhD

New data shows kidney transplantation from hepatitis C virus (HCV)-infected donors can be safely to HCV-negative recipients.

A team, led by Miklos Z. Molnar, MD, PhD, associate professor of Medicine-Nephrology at the University of Tennessee’s Health Science Center, collected data from 53 recipients in a single center, observational study that included donor and recipient characteristics, liver and kidney graft functions, new infections and de novo donor-specific antibodies, and renal histology.

The mean age of the recipients in the study was 53 ± 11 years, 34% of which were female and 79% of which were African American. The median and interquartile range (IQR) time between the transplant and treatment initiation was 76 (IQR: 68‐88) days.

In the study, all 53 recipients became viremic, 34 of which became viremic with genotype 1a, while 1 participant became viremic with genotype 1b, 3 with genotype 2, and 15 with genotype 3.

Approximately 81% of the recipients did not experience clinically significant increases, which were more than 3 times higher than the upper limit of the normal value in aminotransferase levels, with their HCV RNA levels in the 5-6 log range.

Only 1 patient developed fibrosing cholestatic hepatitis with complete resolution, while all recipients completed antiviral treatment, 100% of which were HCV RNA-negative and achieved 12-week sustained virologic response.

Also, 4 recipients developed acute rejection.

Molnar said the practice of transplanting HCV-infected kidneys to uninfected donors has already been tested in a pair of smaller clinical trials and if implemented as a standard of care could greatly expand the number of kidneys available for transplantation, while reducing wait times for donors.

All patients consented to the surgery 3 separate times prior to the study, after being made aware of the infected kidneys.

Currently, HCV-infected kidneys are transplanted to only the patients already HCV-positive. However, the number of HCV-infected kidneys is substantially greater than the number of available recipients, resulting in 1000 discarded HCV-infected kidneys annually.

While the study included 80 uninfected recipients, thus far the data from 53 recipients is available because the remaining 27 transplants occurred too recently to properly evaluate.

Recently, researchers found that if the US relaxed regulations regarding kidney transplants, they can see annual increase of 132,445 allograft life-years by decreasing the kidney discard rate.

In the cohort study, investigators led by Olivier Aubert, MD, PhD, Paris Translational Research Center for Organ Transplantation, analyzed the use of 156,089 deceased donor kidneys in the US and 29,984 in France, and found that the discard rate in the US is nearly twice of that of France.

Molnar explained in an interview with MD Magazine® accepting more HCV-positive kidneys will go a long way to address this discrepancy.

“This is 1 of the ways to decrease this gap instead of discarding them,” Molnar said. “Roughly between 450 and 1000 per year in US we are discarding Hepatitis C kidneys because we couldn’t find a recipient.”

Of the 156,089 kidneys recovered in the US during the 10-year study period, 128,102 were transplanted, while 27,987 were discarded. On the other hand, France recovered 29,984 kidneys during that time, transplanting 27,252 of them and discarding 2732 kidneys.

Approximately 5000 patients in the US and 3000 in Europe die annually waiting for a kidney transplant.

The study, “Transplantation of kidneys from hepatitis C—infected donors to hepatitis C–negative recipients: Single center experience,” was published online in the American Journal of Transplantation.