Thursday 14 march 2019
12:51 - 12:54h
Categories: Klinisch, Postersessie
Parallel session: Postersessies 5 - Clinical
K.M. van Dijk, R.C. van Riet, M.W.F. van den Hoogen.
Dept. of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
Background: The scarcity of kidneys for transplantation results in a high mortality rate for waitlisted patients. In comparison with long-term dialysis, kidney transplantation results in better patient survival. However, many kidneys from donors infected with the Hepatitis C Virus (HCV) are being discarded. In this era, a sustained virologic response can be achieved with Direct Acting Antivirals (DAAs). The aim of this systemic review was to examine the consequences and new possibilities of transplanting kidneys from HCV positive donors to HCV negative recipients (D+/R-).
Methods: We searched Pubmed for studies related to transplantations of kidneys from HCV infected donors into HCV negative recipients. We analysed the quality, characteristics and results of these studies. Our primary outcome measurement was the difference in patient survival between the D+/R- group and a control group of HCV negative donors transplanting to HCV negative recipients (D-/R-). Furthermore, as secondary outcome measurements we focussed on graft survival, HCV transmission and cause of death of the recipients.
Results: As a result of our study selection, we included six articles. Patient survival was worse in the D+/R- group in comparison with the D-/R- group. However, the D+/R- group had higher survival rates compared to waitlisted controls (68% respectively 43% (p<0.001)). Graft survival was lower in the D+/R- group compared to the D-/R- group. HCV transmission varied between 62-100%, depending on the rate of viral load testing. One study reported a sustained virologic response of 100% within 30 days with the use of DAAs. Moreover, the most common cause of death were infection and cardiovascular disease. Liver disease was more often reported in the D+/R- group, with an overall incidence of approximately 5-6%.
Conclusions: We conclude that HCV negative recipients have a worse patient and graft survival when transplanted with a kidney from an HCV infected donor. However, despite the high likelihood of viral transmission, acceptance of a kidney from an HCV infected donor could result in superior patient survival compared to remaining on the waiting list. A sustained virologic response could be achieved with DAA treatment. At last, further research is necessary to examine the long-term outcomes.