Preemptive treatment with elbasvir and grazoprevir for Hepatitis C viremic donor to uninfected recipient kidney transplantation

Abstract Long wait times for kidney transplant have prompted investigation into strategies to decrease discard of potentially viable organs. Recent reports suggest that kidneys from Hepatitis C virus (HCV) infected donors may be transplanted into HCV-naive donors followed by direct-acting antiviral therapy. Methods Pilot clinical trial to transplant kidneys from HCV-infected donors into HCV-naive recipients with preemptive use of elbasvir and grazoprevir for twelve weeks. Primary outcome was sustained virologic response twelve weeks after completion of therapy. Secondary outcomes were safety, quality of life, and early viral kinetics. Results Thirty-three patients were screened and eight underwent kidney transplant from an HCV-viremic donor from August 2017 to March 2019. Median donor kidney donor profile index was 31% (range 29% to 65%) and transplanted patients waited a median of 6.5 months (range 1 to 19 months). None had detectable HCV viremia beyond two weeks post-transplant and all achieved sustained virologic response twelve weeks after therapy (SVR12). There were no study-related severe adverse events. One patient experienced early graft loss due to venous thrombosis, the remaining seven patients had excellent allograft function at six months. Conclusion Preemptive elbasvir and grazoprevir eliminated HCV infection in HCV-naive recipients who received a kidney transplant from an HCV-infected donor.