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Rossetto A, Adani GL, Baccarani U, Tulissi P, Bresadola V. Pathological Consequences in Anti-HCV Antibody-Positive Organ Donation to an Anti-HCV Antibody-Negative Recipient. Transplant Proc 2024; 56:1213-1215. [PMID: 39034192 DOI: 10.1016/j.transproceed.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/05/2024] [Accepted: 02/15/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND The need to expand the pool of available organs for transplantation has meant that the use of marginal organs is increasingly widespread. The advent of antiviral therapy for hepatitis C virus (HCV) has made it possible to consider the donation of organs from HCV-positive donors and even from viremic donors. METHODS In HCV-positive to HCV-negative antibody donor transplantation, the development of antibodies to HCV is uneven, depending on the organ transplanted and with differences in the time of appearance. Whether the subsequent disappearance is attributed to the development of antibodies or the transmission of immunity between donor and recipient remains unclear. In transplantation from an HCV-infected donor to a HCV-seronegative recipient, the administration of antiviral therapy to the recipient before transplantation or a few days after transplantation achieves sustained response in almost all cases. We wanted to deepen the argument by studying the data in the literature, focusing on kidney transplantation, considering that this could be of interest, particularly for possible long-term renal damage. RESULTS HCV infection both ongoing and previous, as well as the presence of HCV antibodies alone, can be responsible for kidney damage. CONCLUSIONS Direct-acting anti-HCV therapy has revolutionized the treatment of HCV disease and the therapeutic possibilities of transplantation. However, we believe it is useful to keep in mind the pathophysiology of HCV-related damage especially in patients with a long life expectancy, using all emerging strategies to minimize the risk of transmission of infection or development of viremia.
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Affiliation(s)
- Anna Rossetto
- General Surgery Unit, Area Medical Department, University of Udine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
| | - Gian Luigi Adani
- General Surgery and Kidney Transplantation, Siena University Hospital, Siena, Italy
| | - Umberto Baccarani
- General Surgery and Transplantation, Area Medica Department, University of Udine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Patrizia Tulissi
- Department of Nephrology, Dialysis, and Kidney Transplantation, Azienda Sanitaria Universitaria Friuli Centrale Udine, Italy
| | - Vittorio Bresadola
- General Surgery Unit, Area Medical Department, University of Udine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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Molnar MZ, Nair S, Cseprekal O, Yazawa M, Talwar M, Balaraman V, Podila PSB, Mas V, Maluf D, Helmick RA, Campos L, Nezakatgoo N, Eymard C, Horton P, Verma R, Jenkins AH, Handley CR, Snyder HS, Cummings C, Agbim UA, Maliakkal B, Satapathy SK, Eason JD. Transplantation of kidneys from hepatitis C-infected donors to hepatitis C-negative recipients: Single center experience. Am J Transplant 2019; 19:3046-3057. [PMID: 31306549 DOI: 10.1111/ajt.15530] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 07/02/2019] [Accepted: 07/05/2019] [Indexed: 01/25/2023]
Abstract
Our aim was to evaluate the safety of transplanting kidneys from HCV-infected donors in HCV-uninfected recipients. Data collected from 53 recipients in a single center, observational study included donor and recipient characteristics, liver and kidney graft function, new infections and de novo donor-specific antibodies and renal histology. Treatment with a direct-acting antiviral regimen was initiated when HCV RNA was detected. The mean ± SD age of recipients was 53 ± 11 years, 34% were female, 19% and 79% of recipients were white and African American, respectively. The median and interquartile range (IQR) time between transplant and treatment initiation was 76 (IQR: 68-88) days. All 53 recipients became viremic (genotype: 1a [N = 34], 1b [N = 1], 2 [N = 3], and 3 [N = 15]). The majority (81%) of recipients did not experience clinically significant increases (>3 times higher than upper limit of the normal value) in aminotransferase levels and their HCV RNA levels were in the 5 to 6 log range. One patient developed fibrosing cholestatic hepatitis with complete resolution. All recipients completed antiviral treatment and 100% were HCV RNA-negative and achieved 12-week sustained virologic response. The estimated GFRs at end of treatment and 12-week posttreatment were 67 ± 21 mL/min/1.73 m2 and 67 ± 17 mL/min/1.73 m2 , respectively. Four recipients developed acute rejection. Kidney transplantation from HCV-infected donors to HCV-negative recipients should be considered in all eligible patients.
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Affiliation(s)
- Miklos Z Molnar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.,Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Satheesh Nair
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Orsolya Cseprekal
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Masahiko Yazawa
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Divison of Nephrology and Hypertension, St. Marianna University School of Medicine, Tokyo, Japan
| | - Manish Talwar
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Vasanthi Balaraman
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Pradeep S B Podila
- Faith & Health Division, Methodist Le Bonheur Healthcare, Memphis, Tennessee.,Division of Health Systems Management & Policy, School of Public Health, The University of Memphis, Memphis, Tennessee
| | - Valeria Mas
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Daniel Maluf
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ryan A Helmick
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Luis Campos
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Nosratollah Nezakatgoo
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Corey Eymard
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Peter Horton
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Rajanshu Verma
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ann Holbrook Jenkins
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee
| | - Charlotte R Handley
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee
| | - Heather S Snyder
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee
| | - Carolyn Cummings
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee
| | - Uchenna A Agbim
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Benedict Maliakkal
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sanjaya K Satapathy
- Sandra Atlas Bass Center for Liver Diseases & Transplantation, Zucker School of Medicine at Hofstra, Department of Medicine, Northshore University Hospital/Northwell Health, Manhasset, New York
| | - James D Eason
- James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee.,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
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Eisenberger U, Friebus-Kardash J, Guberina H, Kribben A, Witzke O, Willuweit K, Gerken G, Herzer K. Treatment With Grazoprevir/Elbasvir for Renal Transplant Recipients With Chronic Hepatitis C Virus Infection and Impaired Allograft Function. Transplant Direct 2019; 5:e419. [PMID: 30656217 PMCID: PMC6324915 DOI: 10.1097/txd.0000000000000860] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/26/2018] [Accepted: 11/14/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Direct-acing antiviral agents are highly efficient treatment options for chronic hepatitis C virus (HCV) infection after renal allograft transplantation. Treatment options for patients with impaired graft function remain limited. Therefore, we assessed the effectiveness and safety of grazoprevir/elbasvir therapy for patients with chronic HCV infection and impaired renal allograft function. METHODS Eleven renal allograft recipients with therapy-naïve HCV genotype (GT) 1a, 1b, or 4 were treated with the fixed-dose combination of elbasvir/grazoprevir without ribavirin for 12 weeks. All recipients exhibited impaired graft function with an average glomerular filtration rate lower than 30 mL/min per 1.73 m2. Clinical data were retrospectively reviewed for renal and liver function parameters. Patients were closely monitored for trough levels of immunosuppressive agents, viral load, laboratory values, and potential adverse effects. RESULTS Seven (64%) patients exhibited a rapid virologic response within 4 weeks (HCV GT1a, n = 2; HCV GT1b, n = 5). The other 4 patients exhibited a virologic response within 8 weeks (HCV GT1b, n = 3; HCV GT 4, n = 1). All patients exhibited a sustained virologic response at week 12 after the end of treatment. Clinical measures of liver function improved substantially for all patients. Few adverse effects were reported. Impaired renal allograft function and proteinuria remained stable. For most patients, only moderate adjustments to the tacrolimus dosage were necessary for maintaining sufficient trough levels. CONCLUSIONS This treatment appears to be safe and effective for renal transplant recipients with impaired allograft function and is a promising treatment option for eradicating HCV infection in this patient population.
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Affiliation(s)
- Ute Eisenberger
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Justa Friebus-Kardash
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Hana Guberina
- Department of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Andreas Kribben
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Katharina Willuweit
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Guido Gerken
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Kerstin Herzer
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
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Shike H, Kadry Z, Imamura-Kawasawa Y, Greene W, Riley T, Nathan HM, Hasz RD, Jain A. Hepatitis C virus (HCV) RNA level in plasma and kidney tissue in HCV antibody-positive donors: Quantitative comparison. Clin Transplant 2018; 32:e13358. [PMID: 30044009 DOI: 10.1111/ctr.13358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 06/22/2018] [Accepted: 07/21/2018] [Indexed: 01/15/2023]
Abstract
Kidney transplant from donors with hepatitis C virus (HCV) antibody has been limited to HCV viremic recipients only, due to concern of the HCV transmission. However, the new antiviral medications provide an opportunity to expand the utilization of these donors. To study the risk of HCV transmission in kidney transplantation, we used discarded donor kidneys and determined HCV RNA levels by quantitative real-time PCR in bilateral (right and left) kidney biopsies and plasma from 14 HCV antibody-positive donors (sensitivity: 15 international unit (IU)/mL plasma; 1.8 IU/50 nL kidney). In three NAT-negative donors, HCV RNA was negative in plasma and kidney. In all 11 NAT-positive donors, HCV RNA was positive in plasma (range: 5807-19 134 177 IU/mL) but negative in six kidneys from four donors with plasma HCV RNA <1.5 million IU/μL. HCV RNA correlated between right and left kidneys (P = 0.75) and between kidney and plasma (r = 0.86). When normalized by volume, HCV RNA median (range) was 49 (0-957) IU/50 nL plasma and 1.0 (0-103) IU/50 nL kidney, significantly lower in kidney (P = 0.005) than in plasma (14-fold). Plasma HCV RNA can be used to predict the kidney HCV load. Future studies are needed if plasma/kidney HCV levels can be used to stratify donors for transmission risk and recipients for post-transplant management in extended utilization of HCV antibody-positive donors.
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Affiliation(s)
- Hiroko Shike
- Department of Pathology, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Zakiyah Kadry
- Division of Transplantation, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Yuka Imamura-Kawasawa
- Department of Pharmacology, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania.,Department of Biochemistry and Molecular Biology, Institute for Personalized Medicine, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Wallace Greene
- Department of Pathology, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Thomas Riley
- Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Howard M Nathan
- Gift of Life Donor Program, Organ Procurement Organization, Philadelphia, Pennsylvania
| | - Rick D Hasz
- Gift of Life Donor Program, Organ Procurement Organization, Philadelphia, Pennsylvania
| | - Ashokkumar Jain
- Division of Transplantation, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
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