Utilization of HCV Viremic Kidneys with Genotyping/Subtyping-Free Sofosbuvir/Velpatasvir Treatment Strategy: Experience from China

Hedong Zhang; Qiuhao Liu; Shanbiao Hu; Mingda Zhong; Fenghua Peng; Yong Guo; Chunhua Fang; Manhua Nie; Liang Tan; Helong Dai; Xubiao Xie; Longkai Peng; Gongbin Lan

doi:10.1155/2022/3758744

Utilization of HCV Viremic Kidneys with Genotyping/Subtyping-Free Sofosbuvir/Velpatasvir Treatment Strategy: Experience from China

Biomed Res Int. 2022 Jul 30:2022:3758744. doi: 10.1155/2022/3758744. eCollection 2022.

Authors

Hedong Zhang^{1

2}, Qiuhao Liu^{1

2}, Shanbiao Hu^{1

2}, Mingda Zhong^{1

2}, Fenghua Peng^{1

2}, Yong Guo^{1

2}, Chunhua Fang^{1

2}, Manhua Nie^{1

2}, Liang Tan^{1

2}, Helong Dai^{1

2

3}, Xubiao Xie^{1

2}, Longkai Peng^{1

2

3}, Gongbin Lan^{1

2}

Affiliations

¹ Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China.
² Clinical Research Center for Organ Transplantation in Hunan Province, Changsha, China.
³ Clinical Immunology Center, Central South University, Changsha, China.

Abstract

Background: Owing to the advent of pangenotypic direct-acting antiviral agents (DAAs) for hepatitis C virus (HCV) treatment, utilization of HCV-infected deceased donor kidneys with simplified genotyping/subtyping-free sofosbuvir/velpatasvir (SOF/VEL) treatment strategy is now becoming a promising strategy for expanding the organ donor pool.

Methods: This retrospective, comparative, single-center study included HCV viremic donor kidneys that were transplanted to 9 HCV-positive (HCV Ab-positive) recipients (D+/R+ group) and 14 HCV-negative recipients (D+/R- group) from May 2018 to January 2021. Both groups received prophylaxis with SOF/VEL treatment within 1-week posttransplant devoid of HCV genotyping/subtyping. The primary outcomes were sustained virologic response 12 weeks after completion of therapy (SVR12) and graft survival at 1-year posttransplant.

Results: Baseline characteristics were similar between the HCV D+/R- and D+/R+ groups. The mean age of all recipients was 39.09 ± 9.65 (SD) years, and 73.9% were male. A total of 92.9% (13 out of 14) recipients had pretreatment HCV viremia in the D+/R- group. The pretreatment HCV viral load in the D+/R+ group (5.98, log 10 IU/mL; IQR, 5.28-6.53) was significantly higher than that in the D+/R- group (3.61, log 10 IU/mL; IQR, 2.57-4.57). After SOF/VEL treatment, SVR12 was achieved in all recipients, with a 100% 1-year patient and graft survival rates. The D+/R+ group had a higher incidence of abnormal liver function (44.4% vs. 7.1%). No significant difference was observed between the two groups in terms of DGF, acute rejection, ALT, serum creatinine, and eGFR within 1-year posttransplant. No severe adverse events associated with either HCV viremia or SOF/VEL were observed.

Conclusions: Using a simplified genotyping/subtyping-free SOF/VEL treatment strategy, kidneys from hepatitis C viremic donors for both infected and uninfected recipients presented with safe, excellent, and comparable 1-year outcomes, which can safely expand the donor pool. HCV-positive donor kidneys should be utilized regularly, regardless of the recipient's HCV status.

MeSH terms

Adult
Antiviral Agents
Carbamates
Female
Genotype
Hepacivirus / genetics
Hepatitis C* / drug therapy
Hepatitis C, Chronic*
Heterocyclic Compounds, 4 or More Rings
Humans
Kidney
Male
Middle Aged
Retrospective Studies
Sofosbuvir / therapeutic use
Viremia / drug therapy

Substances

Antiviral Agents
Carbamates
Heterocyclic Compounds, 4 or More Rings
velpatasvir
Sofosbuvir