Kidney transplant outcomes at Duke for patients with hepatitis C virus (HCV) infection are comparable to those of patients who do not have the infection. Specialists attribute the outcomes in part to streamlined but comprehensive assessments by teams from nephrology, hepatology, and surgery to determine transplant eligibility.
Patients with HCV infections seeking kidney transplants at the Duke Division of Abdominal Transplant Surgery initially undergo evaluations using transient elastography to assess the condition of the liver. Depending on the result, some patients can then avoid a liver biopsy.
Because liver fibrosis often requires required specialized treatment, kidney transplant in patients with HCV require a liver biopsy, says Carol Traynor, MD, a kidney transplant specialist in the Duke Division of Abdominal Transplant Surgery.
Direct Acting Antiviral Agents (DAAs) have improved post-transplant outcomes for patients with HCV and have shortened wait times for transplant by allowing the use of previously discarded HCV-positive organs and permitting treatment of HCV after transplant.
Traynor was the lead author of a retrospective cohort study of adults with HCV-positive infection who received deceased donor kidneys transplanted at Duke between 2013 and 2016. The study measured outcomes such as wait time, delayed graft function, acute rejection, and graft and patient survival, as well as long-term creatinine and urine protein levels.
During the two-year study period, 25 patients with HCV received kidney transplants and were observed for at least 12 months during a two-year period. The patients demonstrated excellent sustained virologic response rates following treatment with DAAs and 95 percent graft survival at one year—outcomes comparable to transplants that did not involve HCV-positive organs.
Among patients in the study, median wait time for a donor organ was 466 days for patients who accepted kidneys from donors with HCV infection compared with 2,169 days for those who received HCV-negative organs. Depending on blood type, wait time for an HCV-negative kidney can extend to seven or eight years.
More than 2.7 million Americans have HCV infection according to recent analyses, although more than 50 percent of the population has not been tested, experts caution. Testing is recommended for individuals between the ages of 45 and 65. Individuals considered to be at risk include injection drug users, persons who have been incarcerated, health care workers, transplant patients, and patients dependent on long-term hemodialysis.
“HCV occurs more frequently in our population of patients and is a factor in chronic kidney disease,” Traynor says. “It is associated with less favorable outcomes, both in terms of progression to end-stage kidney disease as well as higher mortality rates.” As a result of the introduction of DAAs, however, patients with HCV who are on dialysis have increased access to transplant as well as favorable outcomes after transplant.
