Direct-acting antivirals (DAAs) can prevent hepatitis C virus (HCV) transmission from HCV-infected kidney donors to noninfected recipients, according to an initial clinical trial in the Annals of Internal Medicine.
The open-label trial included 10 non-HCV–infected patients receiving kidneys from HCV-infected donors at one transplant center. All recipients were over age 50 (median 71 years) and had no available living donor. The deceased donors, median age 30 years, had positive HCV RNA and HCV antibody test results. Six donors had died of drug overdose.
Immediately before transplantation, all patients were treated with grazoprevir (GZR) 100 mg and elbasvir (EBR) 50 mg. Those whose donors were infected with HCV genotype 1 received GZR-EBR for 12 weeks posttransplant; those whose donors had genotype 2 or 3 received triple therapy with sofosbuvir 400 mg added to GZR-EBR.
On safety analysis, none of the 10 recipients had adverse events related to GZR-EBR. At 12 weeks after treatment, none of the patients had detectable HCV RNA. Five patients never had detectable HCV RNA, suggesting that DAA treatment also prevented acute HCV infection.
Now that DAA agents with high cure rates are available, transplantation from HCV-infected deceased donors—a generally young group with few comorbid conditions—may be possible. This nonrandomized trial shows the feasibility of DAA prophylaxis for non-HCV–infected recipients of kidneys from HCV-infected donors.
The researchers conclude, “If confirmed in larger studies, this strategy should markedly expand organ options and reduce mortality for kidney transplant candidates without HCV infection” [Durand CM, et al. Direct-acting antiviral prophylaxis in kidney transplantation from hepatitis C virus–infected donors to noninfected recipients: an open-label nonrandomized trial. Ann Intern Med 2018; DOI: 10.7326/M17-2871].