Prophylactic Antivirals Prevent Infection in Patients Receiving Kidneys from HCV Positive Donors
Consultant Surgeon Andrew Ready and his team conduct a live donor kidney transplant at The Queen Elizabeth Hospital Birmingham
Kidneys coming from deceased donors with HCV or hepatitis C virus are growingly available. Yet, a lot of them get discarded each year due to the limited number of "HCV-viremic candidates."
An innovative strategy of kidney transplant procedure "from HCV-positive donors to HCV-negative recipients" through the use of the so-called "direct-acting antivirals or DAAs has exhibited early success although DAA therapy's optimal timing and duration stay unclear.
According to the Annals of Internal Medicine, the first DAA prophylaxis trial, specifically the first dose prior to transplant, succeeded by a transplant course, found that a course of 12 weeks prevented chronic infection of HCV minus the complications in 10 kidney recipients.
In relation to this, in its next issue, the Annals of Internal Medicine is publishing articles featuring "prophylactic antivirals" that prevent chronic HCV in patients receiving kidneys from positive donors.
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Previous Studies
Previous research indicates that in the United States, over 420,000 people required hemodialysis for end-stage kidney disease.
These individuals faced a high mortality rate at "169 in ever 1,000 patient-years" compared to 30 in every 1,000 patient-years for recipients of kidney transplant KT.
Moreover, according to the study, the survival benefit of the said transplant has been well established and continues even with the utilization of kidneys' marginal benefactors.
Nonetheless, according to the study authors, there is insufficiency in organs for the transplant. Depending on location, the waiting period for a kidney transplant may take a maximum of 10 years. It is approximated that over half of the total number of candidates on the waiting list die even before they get a transplant.
Consequently, the expansion of the list of donors, according to the research, would have a considerable benefit to public health.
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HCV+ Deceased Donors
Research also found that kidneys coming from HCV+ deceased donors are said to be "underused." From 2015 until 2014, more than 2,600 donor kidneys that were HCV+ were reportedly recovered in the US with the purpose of transplantation were rejected.
Essentially, nationwide research presented that HCV+ donor kidneys are about "2.9 times more likely" to be rejected than the HCV- donor kidneys of similar quality despite providing a survival benefit compared to staying on dialysis.
The said excess rejection might be partly because of a lack of candidates for HCV+ transplant for kidneys and a rising number of available HCV+ benefactors. Generally, young with several other "medical comorbidities" and kidney transplant results from these benefactors have been reportedly excellent.
Lastly, the mains safety final stage was the occurrence of unfavorable events linked to DAA treatment in patients. More so, the main effectiveness endpoint was the patients' proportion with what the study authors described as an "HCV RNA < LLOQ at follow-up week 12" following stoppage of DAAs in all individuals enrolled in the study and were given study drugs.
The Johns Hopkins Medicine Institutional Review Board approved this particular study, which was conducted in conformity with the Good Clinical Practice guidelines. It was reviewed by the Food and Drug Administration and was identified as exempted from "requiring an IND."
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Sep 08, 2020 08:12 AM EDT
