Introduction:
Direct Acting Antiviral (DAA) agents allow the option for successfully transplanting organs from Hepatitis C viremic donors into Hepatitis C negative recipients with viral eradication. The DAA combination of Sofosbuvir/Velpatasvir is pan-genotypic and can be used in patients with impaired kidney function without the need for dose modification and has manageable drug interactions.
Methods:
We report our experience with 6 kidney transplant recipients from Hepatitis C viremic deceased donors (Hep C PCR positive) during 2021-24, marking the initial reports from Australasia. All the recipients received treatment with Sofosbuvir/Velpatasvir 400mg/100mg once daily for varying periods as described.
Recipients were aged between 20-70 years (5 Male). All the recipients received detailed counselling prior to transplant surgery regarding the risk of Hep C transmission, the need
for oral antiviral medications and informed consent obtained. They received standard triple immunosuppression with Basiliximab induction, with immediate and excellent recovery of graft function.
Over this period, we treated the first 2 recipients of the cohort after confirming Hep C viremia at 4 days following transplant for 12 weeks and demonstrated Sustained Virologic Response (SVR).
The next 2 recipients received DAA starting from day 1 post-transplant for 4 weeks with SVR.
The most recent 2 recipients received DAA starting pre-transplant on Day 0, without waiting for Hep C viremia to occur and received treatment for a total of 8 days. The Hep C PCR was negative at Day 5 post-transplant and at Day 90, indicating SVR.
Results:
We have demonstrated Sustained Virologic Response in kidney transplant recipients receiving Hep C viremic donor kidneys, treated with DAA for progressively shorter periods from 12 weeks to 1 week.
Conclusions:
DAA are highly effective in achieving SVR in recipients receiving kidneys from Hep C viremic donors. With shorter duration of treatment, the cost of the DAA is considerably reduced, alleviating the
financial barrier to transplanting organs from Hep C positive donors.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.