Kidney Transplantation From HCV-Positive to HCV-Negative Patients
Kidney transplantation from donors with hepatitis C virus (HCV) to recipients without HCV is effective with 4 weeks of direct-acting antiviral (DAA) therapy, according to results from the REHANNA trial.1
To learn more about the results from the trial, Consultant spoke with lead author Christine M. Durand, MD, who is an associate professor of medicine in Transplant Infectious Diseases at Johns Hopkins University School of Medicine (Baltimore, Maryland).
C360: You and your colleagues conducted the REHANNA (Renal Transplants in Hepatitis C Negative Recipients With RNA Positive Donors) clinical trial, for which you investigated outcomes with 4-week prophylaxis with glecaprevir and pibrentasvir. To start, what prompted you to conduct this trial?
Christine Durand: There is a serious organ shortage for people waiting for a kidney transplant. Kidneys from donors with HCV are increasingly available. By using DAA drugs to prevent or treat HCV, we can now safely transplant kidneys from donors with HCV into recipients without HCV.
C360: Your analysis included patients who had HCV antibody and RNA negativity, were on the deceased-donor kidney transplant waitlist, and did not have HIV, active hepatitis B virus, or liver disease. Can you talk about how these participants received glecaprevir and pibrentasvir therapy and who benefitted the most from this therapy?
CD: We used a prevention strategy where we give DAAs with the first dose immediately before the transplant, continuing through 4 weeks after transplant. We prefer this prophylaxis strategy to a so-called “transmit and treat” approach where recipients acquire HCV from the donor and receive treatment after transplant. We previously showed that 12-week prophylaxis with DAAs was effective in our EXPANDER trial.2 The current trial, REHANNA, investigated a shorter 4-week prophylaxis course.
C360: Ultimately, your team found that among patients who received a kidney from an HCV-positive donor, 4-week glecaprevir and pibrentasvir prophylaxis prevented HCV without treatment-related adverse events or substantial liver enzyme abnormalities. How might these findings impact clinical practice and how transplants from HCV-positive donors are handled in the future?
CD: Our results suggest that 4 weeks of DAAs given immediately before and after transplant could be used widely as a strategy to utilize kidneys from donors with HCV. This would increase access to transplant, could prevent clinical complications, and would cost less than a transmit-and-treat approach, which requires 8 to 12 weeks of DAAs.
C360: You mentioned before that transplant waitlists are ever-growing, but there are increasingly available donors with chronic conditions like HCV. In your opinion, do you think transplanting organs from donors with chronic diseases will become routine in the future, therefore reducing the transplant wait times?
CD: Given the organ shortage, we are always looking for ways to better utilize organs donated, including from donors with chronic conditions.
References:
- Durand CM, Barnaba B, Yu S, et al. Four-week direct-acting antiviral prophylaxis for kidney transplantation from hepatitis C-viremic donors to hepatitis c-negative recipients: an open-label nonrandomized study. Ann Intern Med. 2021;175(1):137-138. doi:10.7326/m20-1468
- Durand CM, Bowring MG, Brown DM, 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;168(8):533-540. https://doi.org/10.7326/m17-2871