Four-Week Direct-Acting Antiviral Prophylaxis for Kidney Transplantation From Hepatitis C–Viremic Donors to Hepatitis C–Negative Recipients: An Open-Label Nonrandomized Study
Authors: Christine M. Durand, Brittany Barnaba, Sile Yu, Diane M. Brown, Michael A. Chattergoon, Nichole Bair, Fizza F. Naqvi, Mark Sulkowski, Dorry L. Segev, Niraj M. Desai
Journal: Annals of Internal Medicine (2020)

LettersJanuary 2021Four-Week Direct-Acting Antiviral Prophylaxis for Kidney Transplantation From Hepatitis C–Viremic Donors to Hepatitis C–Negative Recipients: An Open-Label Nonrandomized StudyChristine M. Durand, MD, Brittany Barnaba, MS, Sile Yu, MD, Diane M. Brown, MSN, Michael A. Chattergoon, MD, Nichole Bair, BSN, Fizza F. Naqvi, MD, Mark Sulkowski, MD, Dorry L. Segev, MD, and Niraj M. Desai, MDChristine M. Durand, MDJohns Hopkins University School of Medicine, Baltimore, Maryland (C.M.D., B.B., S.Y., D.M.B., M.A.C., N.B., F.F.N., M.S., D.L.S., N.M.D.), Brittany Barnaba, MSJohns Hopkins University School of Medicine, Baltimore, Maryland (C.M.D., B.B., S.Y., D.M.B., M.A.C., N.B., F.F.N., M.S., D.L.S., N.M.D.), Sile Yu, MDJohns Hopkins University School of Medicine, Baltimore, Maryland (C.M.D., B.B., S.Y., D.M.B., M.A.C., N.B., F.F.N., M.S., D.L.S., N.M.D.), Diane M. Brown, MSNJohns Hopkins University School of Medicine, Baltimore, Maryland (C.M.D., B.B., S.Y., D.M.B., M.A.C., N.B., F.F.N., M.S., D.L.S., N.M.D.), Michael A. Chattergoon, MDJohns Hopkins University School of Medicine, Baltimore, Maryland (C.M.D., B.B., S.Y., D.M.B., M.A.C., N.B., F.F.N., M.S., D.L.S., N.M.D.), Nichole Bair, BSNJohns Hopkins University School of Medicine, Baltimore, Maryland (C.M.D., B.B., S.Y., D.M.B., M.A.C., N.B., F.F.N., M.S., D.L.S., N.M.D.), Fizza F. Naqvi, MDJohns Hopkins University School of Medicine, Baltimore, Maryland (C.M.D., B.B., S.Y., D.M.B., M.A.C., N.B., F.F.N., M.S., D.L.S., N.M.D.), Mark Sulkowski, MDJohns Hopkins University School of Medicine, Baltimore, Maryland (C.M.D., B.B., S.Y., D.M.B., M.A.C., N.B., F.F.N., M.S., D.L.S., N.M.D.), Dorry L. Segev, MDJohns Hopkins University School of Medicine, Baltimore, Maryland (C.M.D., B.B., S.Y., D.M.B., M.A.C., N.B., F.F.N., M.S., D.L.S., N.M.D.), and Niraj M. Desai, MDJohns Hopkins University School of Medicine, Baltimore, Maryland (C.M.D., B.B., S.Y., D.M.B., M.A.C., N.B., F.F.N., M.S., D.L.S., N.M.D.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-1468 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Kidneys from deceased donors with hepatitis C virus (HCV) are increasingly available, yet hundreds are discarded annually because of a limited number of HCV-viremic candidates. An innovative strategy of transplanting kidneys from HCV-positive donors to HCV-negative recipients (HCV D+/R−) by using direct-acting antivirals (DAAs) has shown early success, but the optimal timing and duration of DAA therapy remain unclear. Our first trial of DAA prophylaxis (first dose before transplant, followed by a posttransplant course) found that a 12-week course prevented chronic HCV infection without complications in 10 recipients (1).Objective: To investigate 4-week prophylaxis with the pangenotypic combination of ...References1. 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;168:533-540. doi:10.7326/M17-2871 LinkGoogle Scholar2. Sise ME, Strohbehn IA, Chute DF, et al. Preemptive treatment with elbasvir and grazoprevir for hepatitis C-viremic donor to uninfected recipient kidney transplantation. Kidney Int Rep. 2020;5:459-467. [PMID: 32280841] doi:10.1016/j.ekir.2020.01.001 CrossrefMedlineGoogle Scholar3. Woolley AE, Singh SK, Goldberg HJ, et al; DONATE HCV Trial Team. Heart and lung transplants from HCV-infected donors to uninfected recipients. N Engl J Med. 2019;380:1606-1617. [PMID: 30946553] doi:10.1056/NEJMoa1812406 CrossrefMedlineGoogle Scholar4. Gupta G, Yakubu I, Bhati CS, et al. Ultra-short duration direct acting antiviral prophylaxis to prevent virus transmission from hepatitis C viremic donors to hepatitis C negative kidney transplant recipients. Am J Transplant. 2020;20:739-751. [PMID: 31652392] doi:10.1111/ajt.15664 CrossrefMedlineGoogle Scholar5. Goldberg DS, Abt PL, Blumberg EA, et al. Trial of transplantation of HCV-infected kidneys into uninfected recipients [Letter]. N Engl J Med. 2017;376:2394-2395. [PMID: 28459186] doi:10.1056/NEJMc1705221 CrossrefMedlineGoogle Scholar6. Molnar MZ, Nair S, Cseprekal O, et al. Transplantation of kidneys from hepatitis C-infected donors to hepatitis C-negative recipients: single center experience. Am J Transplant. 2019;19:3046-3057. [PMID: 31306549] doi:10.1111/ajt.15530 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Johns Hopkins University School of Medicine, Baltimore, Maryland (C.M.D., B.B., S.Y., D.M.B., M.A.C., N.B., F.F.N., M.S., D.L.S., N.M.D.)Financial Support: Dr. Durand is supported by National Cancer Institute grant K23CA177321-01A1. Dr. Segev is supported by grant K24DK101828 from the National Institute of Diabetes and Digestive and Kidney Diseases. A private donor provided funding to purchase glecaprevir–pibrentasvir. The funding sources had no role in the conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-1468.Reproducible Research Statement: Study protocol: Available from Dr. Durand (e-mail, [email protected]edu). Statistical code: Not available. Data set: Requests for deidentified data can be sent to Dr. Durand (e-mail, [email protected]edu). If approved, a data use agreement will be set up to guide terms of use.Corresponding Authors: Christine M. Durand, MD, Department of Medicine, Johns Hopkins School of Medicine, 725 North Wolfe Street, Room 228, Baltimore, MD 21205 (e-mail, [email protected]edu), and Niraj M. Desai, MD, Department of Surgery, Johns Hopkins School of Medicine, 720 Rutland Avenue, Ross 771, Baltimore, MD 21205 (e-mail, [email protected]edu).This article was published at Annals.org on 8 September 2020. 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