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Transplantation of hepatitis C virus infected kidneys into hepatitis C virus uninfected recipients
Author(s) -
Sise Meghan E.,
Chute Donald F.,
Gustafson Jenna L.,
Wojciechowski David,
Elias Nahel,
Chung Raymond T.,
Williams Winfred W.
Publication year - 2018
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/hdi.12650
Subject(s) - medicine , hepatitis c virus , dialysis , hepatitis c , population , kidney transplantation , transplantation , kidney , hemodialysis , mortality rate , immunology , intensive care medicine , virus , environmental health
Long wait times for kidney transplant and the high risk of mortality on dialysis have prompted investigation into strategies to increase organ allocation and decrease discard rates of potentially viable kidneys. Organs from hepatitis C virus (HCV) antibody positive donors are often rejected; nearly 500 HCV‐infected kidneys are discarded annually in the United States. Due the opioid epidemic, the number of HCV‐infected donors has increased because of a rise in both new HCV infections and drug‐related deaths. In the past 5 years, HCV has been transformed into a curable illness with direct‐acting antiviral therapies (DAAs) that are effective in >95% of patients treated and are extremely well tolerated. Recent data has shown several direct‐acting antiviral combinations are safe and effective after kidney transplant, and can achieve the same high cure rate seen in the general population and without increasing the rate of acute rejection. Because of this, strategies to decrease discard of HCV‐infected organs have been devised. Two recent studies have transplanted HCV‐uninfected dialysis patients with kidneys from donors actively infected with HCV; recipients were treated with DAA in the peri‐transplant period. More research is needed to determine the safety and efficacy of this approach, but it has the potential to dramatically increase the donor pool of available kidneys, shorten waitlist times and ultimately decreases mortality in patients waiting for kidney transplant.