Demographic And Clinical Data
Patients were asked for demographic information , waitlist time, dialysis time, type of dialysis, and history of a prior kidney transplant. Patients were also asked if they had been diagnosed and/or treated for HCV and if they had any personal contacts with known history of HCV. They were then asked to respond to three hypothetical kidney offers as follows: 1) 20-year-old HCV-infected donor with a greater than 95% chance of successful HCV cure following transplant 2) 20-year-old PHS-increased risk donor with active IVDU at time of death and 3) 70-year-old donor with long-standing hypertension and diabetes. For those patients who reported no to any organ offer, they were then asked to indicate how much additional time they would be willing to remain on the transplant list in order to receive a standard kidney offer. Finally, patients were asked if added costs or doctor visits for HCV treatment were of concern to them. A full copy of the survey is included as Additional file .
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Opioid Overdoses A Bittersweet Source Of Donor Organs
The increased supply of donor organs from hepatitis C patients is driven in part by the opioid epidemic, Gupta said. Overdoses cause deaths in an otherwise healthy person, whose organs would generally be considered safe for transplant. Sharing needles, though, can transmit hepatitis C.
Theres sadly been a huge surge of organs lungs, hearts, livers, kidneys that have become available for transplant due to the opioid pandemic, Gupta said.
Currently, researchers are looking at ways to change preventative drugs to drop the risk of transmission to zero. Gupta is also looking at long-term outcomes to understand whether there are any consequences to the treatment. We dont believe so, he said. But thats what we do in science measure things that may not have been accounted for before.
Hcv+ To Hcv Kidney Transplantation
Several centres have made significant progress in this field over the past 5 years . Initial studies used 12 week regimens of Gazoprevir and Elbasvir in small single centre prospective cohorts to good effect, demonstrating 100% SVR12 . These studies used majority DBD donors with median ages , demonstrating the advantageous demographics previously described in HCV-positive donors . Different timepoints for the onset of DAA regimens were used by these study groups. In the THINKER trial, Goldberg et al initiated the DAA regime on post-transplant day 3 after HCV viraemia had been detected within the transplant recipients, whereas Durand et al opted for a pre-emptive approach in EXPANDER. This initiated DAA therapy immediately post-transplant. These two strategies of transmit and treat versus prophylactic regimens have been mirrored in subsequent generations of peri-transplant DAA studies. As DAA studies in this field have emerged as successful and safe, investigators have sought to determine the optimal course timing and duration, without sacrificing efficacy .
TABLE 1. Studies investigating HCV+/HCV- kidney transplant with DAA regimes.
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Induction And Maintenance Immunosuppression Protocol
All recipients received rabbit antithymocyte globulin induction therapy with a planned cumulative dose of 4.5 mg/kg divided into three doses. All recipients were started on a triple immunosuppressive regimen consisting of tacrolimus, mycophenolic acid, and prednisone unless they had a contraindication, and remained on a maintenance dose of prednisone 5 mg daily per protocol.
De Novo Glomerulonephritis And Chronic Allograft Nephropathy After Kidney Transplant In Hcv+ve Recipient
In addition to an increased disease burden due to liver disease and an association with all-cause and cardiovascular disease mortality, HCV infection in kidney transplant recipients has been implicated in the pathogenesis of acute glomerulopathy , de novo immune complex glomerulonephritis in the allograft , and, in some reports, a higher rate of chronic allograft nephropathy .
HCV infection is one of the most important factors predisposing to the development of glomerulonephritis in the native kidney and in the renal allograft and the high prevalence of HCV infection in renal allograft recipients places this group at high risk of immune-mediated glomerular diseases. In de novo membranoproliferative glomerulonephritis and de novo membranous glomerulopathy , with or without mixed cryoglobulinemia, are the most most frequent glomerular lesion associated with chronic HCV infection in renal allografts .
In 2001, Cruzado et al. reported a prevalence of de novo MPGN and MGN in HCV+ve kidney recipients of 45.4% and 18.2%, respectively, versus a lower rate in HCVve recipients of 5.7% and 7.7%, respectively. These data have been confirmed in 2006 by Ozdemir et al. who reported a prevalence of de novo GN in HCV-infected recipients of 34%, compared to 6.6% in HCVve recipients. In both studies, this higher prevalence of autoimmune GN was associated with a poor graft outcome, even worse than de novo GN in HCVve.
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Getting A Kidney Transplant From A Person Who Has Hepatitis C When You Don’t Have Hepatitis C
Within the last few years, there have been a few cases where doctors transplant a hepatitis C-infected kidney into the body of a person without hepatitis C. This means that when you receive your new kidney, you will probably become infected with hepatitis C. But once you receive your new kidney, you will be treated with drugs to cure the hepatitis C.
The health of people who receive a kidney transplant is better than the health of people on long-term dialysis. Hepatitis C can be cured without too many side effects. This makes getting a kidney transplant the top priority.
Researchers are still studying this type of transplant, but it has shown very positive results for patients who have had it done so far.
Is Pregnancy Safe For Kidney Transplant Recipients With Chronic Hepatitis C Virus Nfection An Updated Review
Ethem Unal1*, Abdullah Yildiz1, Sema Yuksekdag1, Aysun Firat2 and Nevin Yilmaz3
1Department of Surgery, Health Sciences University, Umraniye Education and Research Hospital, Turkey
2Department of Obstetrics & Gynecology, Health Sciences University, Istanbul Education and Research Hospital, Turkey
3Department of Gastroenterology and Hepatology, Medical Faculty, Eastern Mediterranean University, Magosa, Turkish Republic of Northern Cyprus
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Transplanting Hepatitis Cpositive Kidneys Appears Safe And Effective
A recent study found that transplanting such kidneys and then treating the recipient for hep C worked well.
People waiting for a kidney transplant may do well to receive such an organ from a donor with hepatitis C virus , MedPage Today reports. A recent small study found that doing so and then treating the recipient with direct-acting antivirals was safe and effective.
Publishing their findings in the Annals of Internal Medicine, researchers conducted a study of 20 HCV-negative individuals who were awaiting a kidney transplant. They received kidneys from 15 different HCV-positive donors. Ten of the participants were enrolled in the THINKER-1 study, and the other 10 were enrolled in the EXPANDER study.
After they received their kidneys, most of the participants were treated with 12 weeks of Zepatier. Three of the participants had hep C with mutations associated with resistance to NS5A inhibitor DAAs, so they received 16 weeks of Zepatier plus ribavirin according to protocol. All participants were treated with standard immunosuppression therapy to prevent rejection of their new organ.
All participants achieved a sustained virologic response 12 weeks after completing DAA therapy .
As for creatinine levels , six months post-surgery the results for both HCV-positive and -negative individuals were a respective 1.2 and 1.2 milligrams per deciliter. Twelve months post-surgery the results were a respective 1.1 and 1.1 mg/dl.
To read a press release about the study, .
Kidney Transplant From Hepatitis C Donor
Sometimes waiting for a kidney transplant takes a long time as long as 5-10 years. So, some people accept a kidney with hepatitis C to help them get transplanted sooner.
Hepatitis C is a curable virus that causes liver disease. It can be cured 97 times out of 100 with medication. The virus will not harm your liver once you are cured. It also will not harm your new kidney.
Learn more about accepting a kidney with hepatitis C by watching the below video.
Register for an informational webinar on Wednesday, June 9, 2021 at 6:00 p.m.
Please contact your pre-transplant coordinator with any questions.
In This Section:
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Future Considerations For United Kingdom Application
Real world data from the US has demonstrated that outside of clinical trials, where regimens are supplied by manufacturers or funding for DAA therapy is guaranteed, there have been difficulties in acquiring approval from insurers following HCV transmission . Many funders are reluctant to provide cover for a pre-emptive or prophylactic DAA regimen and subsequently favour transmit and treat approaches . Consequently, this has led to delays in treatment . Such delays have the potential to induced sequelae of HCV infection, with serious implications such as fibrosing cholestatic hepatitis . It should be noted that treatment failure has the potential to induce devastating complications including graft loss. Concerns have also been raised regarding the increased risk of the development of BK viraemia and cytomegalovirus and severe cases have coincided with the formation of de novo donor specific antibodies . Studies to date have not noted significant difference in the prevalence of such viral complications, but when such events occur, the severity has been increased . Consequently, thorough surveillance strategies will be required.
Donor Acceptance And Recipient Selection
Our center accepted HCV NATâpositive and/or HCV antibodyâpositive donors who were younger than 45 years old and had a donor biopsy showing < 10% glomerular sclerosis. We offered these organs to recipients who previously agreed to accept HCV-infected donor kidneys. These organs were not offered to patients with a history of severe liver disease or HIV infection.
The consenting process included three separate steps. Initially, all waitlisted recipients and their primary nephrologists received a letter, along with a consent form , from our center to inform them of our new standard of care. These waitlisted patients were asked to sign and send back the consent form prior to surgery without any personal encounter between provider and patient. All active waitlisted patients were listed for HCV-infected donor kidneys if the recipients did not have the contraindication listed above. Secondly, waitlisted patients were counseled again by our transplant coordinators and transplant nephrologists at the time of the call-in for organ availability, where transmission rate, potential complications of hepatitis C, our treatment plan, and our experience were discussed with the patient. Finally, all recipients were counseled again personally by transplant surgeons and transplant nephrologists immediately before surgery at which time they also signed the consent form.
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Baseline Recipient Donor And Transplantation Characteristics
Baseline characteristics of recipients and donors are shown in Table . The mean Â± SD age of recipients was 53 Â± 11 years, 34% were female, 19% and 79% of patients were white and African American, respectively. The majority of our recipients had Medicare as primary insurance. More than half of the patients had diabetes as a comorbidity, 11% had peripheral vascular disease, and 17% had coronary artery disease. The median and IQR time on dialysis before transplantation was 49 months.
- Abbreviations: KDPI, Kidney Donor Profile Index.
Can I Receive A Kidney Transplant If I Have Hepatitis C
Yes, its possible to receive a kidney transplant if you have hepatitis C. Being HCV-positive shouldnt affect your eligibility. With that said, not everyone who has HCV is a good candidate for transplantation and it can be difficult to procure a donor kidney.
Your healthcare team will conduct extensive tests before recommending a transplant. If youre HCV-positive, theyll pay extra attention to your liver health. If you have complications, such as cirrhosis or liver cancer, you might not be healthy enough to undergo a kidney transplant.
On the other hand, if your liver is compromised but youre otherwise healthy, your healthcare team might consider doing a liver transplant alongside your kidney transplant. This option can involve a longer wait, though, as it requires two donor organs.
If youre recommended for a transplant, a friend or family member might be able to donate one of their kidneys to you. Otherwise, youll be placed on the Organ Procurement and Transplantation Network waiting list for a kidney from a recently deceased person.
You might have to wait more than 5 years. If youre HCV-positive, you could potentially receive a transplant faster by accepting a kidney from an HCV-positive donor.
new medical regimen for HCV revolutionized treatment.
Direct-acting antivirals can now eradicate the virus in most people. This is known as a sustained virologic response , and it means that the virus is no longer detectable in your body after a certain amount of time.
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Therapy Of Chronic Hcv Infection In Kidney Transplant Recipients
The efficacy and safety of IFN-based therapy of hepatitis C after KT is unsatisfactory . The potential benefits need to be weighed against the risk of allograft rejection.
The administration of IFN after kidney transplantation can be deleterious to the allograft and should generally be avoided in kidney transplant recipients unless there is indication of worsening hepatic injury on biopsy or clinically decompensating liver disease. Reported rates of kidney graft dysfunction after IFN treatment range from 9 to 100%, with most episodes occurring between 0.3 and 8 months after initiation of therapy. Most kidney graft dysfunction was related to increased rates of acute rejection, which is frequently steroid resistant and irreversible and could lead to graft loss .
Apart from the antiviral effects mediated through the Jak-Stat signaling pathway, IFN is a potent immunomodulator affecting both the innate and the adaptive immune system .
While expansions of T-cell clones directed to viral antigens contribute to viral load reduction and clearance, expansions of T-cell clones to alloantigens may trigger immune-related disorders including acute cellular rejection and chronic ductopenic rejection as well as de novo autoimmune hepatitis.
Alternative regimens based on amantadine, RBV monotherapy, or their combination have been proposed, but no proof of their efficacy has been provided , and therefore they are not recommended.
New Life For Kidneys That Are Often Discarded
Traditionally, kidneys from hepatitis C-positive patients have been discarded to avoid transmitting hepatitis C to the transplant recipient. Now that there is a treatment for hepatitis C, some transplant centers do use these kidneys. After transplant, they immediately treat recipients with eight to 12 weeks of anti-viral drugs to eradicate the disease, which is transmitted with the new kidney.
In contrast, at VCU Health Hume-Lee Transplant Center, recipients receive the anti-hepatitis drugs prior to surgery, rather than afterwards. The thinking: prevent transplant recipients from getting hepatitis C in the first place.
Since the initial yearlong trial in 2018, Hume-Lee has successfully transplanted more than 150 kidneys from hepatitis C-positive donors without transferring chronic hepatitis C to the recipients.
We can reassure patients that there is a very low likelihood they will ever get hepatitis C, Gupta said. That helps a lot on the emotional side because most families, particularly spouses, are very concerned that their loved one will get the infection.
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Can I Donate A Kidney If I Have Hepatitis C
In the past, having hepatitis made it impossible to donate a kidney. Now that HCV is curable, recommendations are changing.
Whether you can donate will likely come down to your overall health, and the health of your kidney. If your HCV was left untreated for a long time, your kidneys might be damaged.
Your healthcare team will conduct tests to determine if youre healthy enough to donate a kidney. If youre currently HCV-positive, your doctor might recommend treating the infection with DAAs prior to the transplant surgery to eradicate the virus.
You should ask your doctor whether previously having HCV increases the risk of complications after donating your kidney.
What Is The Impact On The Person Receiving The Transplant
In most cases, kidney transplantation significantly improves an individuals quality of life. A person who receives a new kidney may no longer require dialysis and can return to a more normal life.
However, kidney transplantation is not a cure for chronic kidney disease, and the individual must take medications for the rest of their life. As a result, they may still experience some physical and mental health challenges.
A persons HCV status may also affect their life expectancy following a transplant. In an earlier , doctors found that HCV-positive people have a 5-year survival rate of 77% following a transplant compared with 90% of HCV-negative patients.
However, this survival rate in transplant recipients with HCV is
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Hepatitis C And Kidney Transplantation
1Liver Unit, Queen Elizabeth Hospital, Birmingham B15 2TH, UK
2Department of Nephrology, Queen Elizabeth Hospital, Birmingham B15 2TH, UK
Hepatitis C virus infection is relatively common among patients with end-stage kidney disease on dialysis and kidney transplant recipients. HCV infection in hemodialysis patients is associated with an increased mortality due to liver cirrhosis and hepatocellular carcinoma. The severity of hepatitis C-related liver disease in kidney transplant candidates may predict patient and graft survival after transplant. Liver biopsy remains the gold standard in the assessment of liver fibrosis in this setting. Kidney transplantation, not haemodialysis, seems to be the best treatment for HCV+ve patients with ESKD. Transplantation of kidneys from HCV+ve donors restricted to HCV+ve recipients is safe and associated with a reduction in the waiting time. Simultaneous kidney/liver transplantation should be considered for kidney transplant candidates with HCV-related decompensated cirrhosis. Treatment of HCV is more complex in hemodialysis patients, whereas treatment of HCV recurrence in SLK recipients appears effective and safe.
2. Natural History of Hepatitis C Virus Infection
3. HCV Infection in End-Stage Kidney Disease : Prevalence and Impact on Survival
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