Balancing the risk and rewards of utilizing organs from hepatitis C viremic donors.
Balancing the risk and rewards of utilizing organs from hepatitis C viremic donors. Curr Opin Organ Transplant. 2019 Jun;24(3):351-357 Authors: Sise ME, Strohbehn IA, Bethea E, Gustafson JL, Chung RT Abstract PURPOSE OF REVIEW: Owing to long waitlist times and high waitlist morbidity and mortality, strategies to increase utilization of hepatitis C viremic-deceased donor organs are under investigation in kidney, liver, heart, and lung transplantation. RECENT FINDINGS: Direct-acting antiviral medications for hepatitis C virus infection have high cure rates and are well tolerated. Small, single-center trials in kidney and heart transplant recipients have demonstrated that with early posttransplant direct-acting antiviral therapy, 100% of uninfected recipients of hepatitis C viremic organs have been cured of infection after transplantation. SUMMARY: In this manuscript, we review the risks and rewards of utilizing hepatitis C viremic organs for transplantation. PMID: 31090648 [PubMed - in process]
Authors: Khan MU, Mahmoud MI, Butt AA Abstract INTRODUCTION: Hepatitis C virus (HCV) infection is associated with an increased incidence and progression of chronic kidney disease (CKD), as well as higher mortality in CKD and renal transplant patients. Direct acting antiviral agents (DAAs) have revolutionized the treatment of HCV, with viral eradication attained in 90-100% of treated patients. DAAs have an excellent safety and tolerability profile in CKD and renal transplant patients. AREAS COVERED: In this review, we discuss the association of HCV with incidence and progression of CKD as well as its effect on o...
Conclusion: Post-transplantation treatment of chronic HCV is preferred in KTRs. The sofosbuvir/daclatasvir regimen as an interferon-free therapy is a safe, effective option for HCV infection in pediatric KTRs, who can tolerate sofosbuvir/daclatasvir well and respond favorably without significant adverse events. PMID: 32606888 [PubMed]
CONCLUSION: Within a solid organ transplantation program, clinical pharmacists and other pharmacy personnel can play vital roles in ensuring safe and effective DAA therapy for recipients of transplanted HCV NAT-positive organs. PMID: 32537658 [PubMed - as supplied by publisher]
Authors: Timofte D, Dragos D, Balcangiu-Stroescu AE, Tanasescu MD, Gabriela Balan D, Avino A, Tulin A, Stiru O, Ionescu D Abstract Increase in the number of patients with chronic kidney disease (CKD) calls for improved management of these patients. In stage 5 CKD, when the initiation of renal replacement therapy (RRT) becomes necessary, there is an increase in the infection risk of the patients and immunological tests for hepatitis C virus (HCV) detection turn positive at an alarmingly higher rate compared to general population. With the introduction into clinical practice of diagnostic tests, the increased prevale...
ConclusionsOlder age, BMI, family history of diabetes, tacrolimus use, history of hypertension, polycystic kidney disease, acute rejection, HBV infection, and HCV infection are risk factors for new ‐onset diabetes mellitus after kidney transplantation. Therefore, the clinical implications of these factors warrant attention.
Publication date: Available online 30 May 2020Source: American Journal of Kidney DiseasesAuthor(s): Kristen L. King, S. Ali Husain, Sumit Mohan
CONCLUSION: The absolute number of patients and rates of incidence and prevalence in dialysis in the country increased substantially in the period, although there are considerable differences in rates by state. There has been a persistent increase in the use of venous catheters as an access for dialysis; and reduction in the number of patients with positive serology for hepatitis C. PMID: 32459279 [PubMed - as supplied by publisher]
Donor scarcity, the principal challenge of kidney allocation today, is a result of the success of our field. Over recent decades, we have accomplished dramatic improvements in immunosuppression, perioperative care, and approaches to patient selection. As a result, successful kidney transplantation is all but taken for granted. Consequently, the demand for kidneys continues to far outpace the supply of donated organs. One strategy has been to re-examine how best to use organ categories that were previously thought to be marginal or unusable, such as those from donors infected with hepatitis C virus (HCV).
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Conclusions. In the modern direct-acting antiviral era, calculated likely KDPI overestimates risk kidneys from HCV (+) donors. Donor viremia conveys an early risk which appears to subside over time. These results suggest that it may be time to revise the kidney donor risk index.