The association of donor hepatitis C virus infection with 3-year kidney transplant outcomes in the era of direct-acting antiviral medications
Tarek Alhamad, MD, MS, MBA, Associate Professor of Medicine, Medical Director of Transplant Nephrology, Division of Nephrology, recently had two manuscripts published in JAMA Open and the American Journal of Transplantation regarding new findings of kidney donors updates for those with HCV and COVID-19. These new research findings aim to increase the donor pool to allowing more donations which are critical for those waiting for a kidney transplant.
Right now almost 100,000 patients sit waiting hopeful for a kidney transplantation often times kidney offers are refused due to the donor having HCV or COVID-19. Research outcomes from Dr. Alhamad has confirmed that these kidneys are viable and critical for patients on the donor list.
Before the introduction of highly effective, direct-acting antiretroviral medications (DAAs) for hepatitis C virus (HCV) infection, HCV-positive kidneys, either nucleic acid amplification test positive (NAT+) or antibody positive (Ab+), were transplanted solely into HCV-positive recipients or discarded if an appropriate candidate could not be identified. Now DAAs are offering effective cures for more than 95% of patients with HCV infections after 8 to 12 weeks of treatment.
Now many donors who were once HCV viremic have been cured with DAAs, resulting in an increasingly large pool of seropositive but aviremic (Ab+/NAT-) donor kidneys. The American Society of Transplantation consider now these kidneys to be at low risk for HCV transmission.
Patterns in Use and Transplant Outcomes Among Adult Recipients of Kidneys From Deceased Donors with COVID-19
The COVID-19 pandemic caused an immediate and substantial decrease in solid organ transplant rates globally with kidney transplants being the most affected, followed by lung, liver, and heart transplants. In the U.S., kidney transplants are the most common type of solid organ transplant, with a record 26,000 performed in 2022.
At the beginning of the pandemic, COVID-19-positive patients were not considered eligible to be potential living or deceased donors, resulting in decreased transplants. Dr. Alhamad and his colleagues have published in JAMA Open findings that using kidneys from donors with active or resolved COVID-19 is safe, with excellent outcomes during medium-term follow-ups with recipients.
“The idea is that we should not just discard a kidney because someone had COVID-19. Unfortunately during the epidemic, kidneys were discarded because it was unknown whether types of transmissions would occur during transplants. “
Tarek Alhamad, MD, MS, MBA
Now that they’ve seen the outcomes of transplantation and entered the third year of practice in the COVID-19 era, Dr. Alhamad shares that kidneys from donors with COVID-19 had a very low chance of transmission and come with excellent post-transplant outcomes. We should try our efforts not to discard such valuable organs while we have a very long list of patients waiting for a kidney transplant. Dr. Alhamad shared that a patient waiting for a kidney told him every day without dialysis is worth their entire life.