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The effect of pulsatile pump perfusion on hepatitis C transmission in kidney transplantation: A prospective pilot study
Author(s) -
Forbes Rachel C.,
Concepcion Beatrice P.,
Clapper Deana,
DuBray Bernard J.,
Shawar Saed,
Schaefer Heidi M.,
Langone Anthony,
Shaffer David,
Johnson Keith
Publication year - 2020
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13987
Subject(s) - medicine , viral load , prospective cohort study , pulsatile flow , perfusion , kidney transplantation , transmission (telecommunications) , kidney , transplantation , hepatitis c virus , virus , virology , electrical engineering , engineering
With increasing utilization of hepatitis C (HCV) viremic donor organs, there may be a role for kidney pump perfusion to reduce viral load and prevent HCV transmission. We performed a prospective pilot study of HCV viremic donors; one kidney from each donor pair was pumped with perfusate exchanges and viral load testing at least every 4 hours. Donor, recipient, and transplant characteristics were obtained with clinical outcomes. Linear regression was performed to quantify the association between pump time and perfusate viral load. Six HCV viremic donors for six pairs of aviremic recipients were included. Perfusate of the pumped kidneys showed detectable virus throughout the pump cycles. Although perfusate viral levels decreased with increasing pump times, this was not statistically significant ( β = −.48, P = .36). All recipients had detectable HCV RNA postoperatively. The pumped cohort had an insignificantly reduced mean viral load compared to pumped recipients (1352 ± 2006 vs 26 170 ± 61 211, P = .09). Time to initiation of direct‐acting antiviral was 32 ± 12 vs 26 ± 7 days ( P = .17) and to undetectable levels was 66 ± 27 vs 55 ± 22 days ( P = .82) for the pumped and unpumped cohorts, respectively. Pulsatile perfusion alone does not appear adequate to decrease HCV transmission. Future studies will need to explore additional ex vivo interventions to pumping.