Krista L Lentine1, John D Peipert2,3, Tarek Alhamad4, Yasar Caliskan1, Beatrice P Concepcion5, Rachel Forbes5, Mark Schnitzler1, Su-Hsin Chang4, Matthew Cooper6, Roy D Bloom7, Roslyn B Mannon8, David A Axelrod9. 1. Saint Louis University Center for Abdominal Transplantation, St. Louis, MO. 2. Northwestern University, Feinberg School of Medicine, Chicago, IL. 3. Northwestern University Transplant Outcomes Research Core, Chicago, IL. 4. Washington University, Saint Louis, MO. 5. Vanderbilt Transplant Center, Nashville, TN. 6. Medstar Georgetown Transplant Institute, Washington, DC. 7. University of Pennsylvania, Philadelphia, PA. 8. University of Nebraska, Omaha, NB. 9. University of Iowa, Iowa City, IA.
Abstract
BACKGROUND: Transplant practices related to use of organs from Hepatitis C virus infected donors (DHCV+) is evolving rapidly. METHODS: We surveyed U.S. kidney transplant programs by email and professional society listserv postings between 7/19-1/20 to assess attitudes, management strategies, and barriers related to use of viremic (nucleic acid testing (NAT)+) donor organs in HCV uninfected recipients. RESULTS: Staff at 112 unique programs responded, representing 54% of U.S. adult kidney transplant programs and 69% of adult deceased donor kidney transplant volume in 2019. Most survey respondents were transplant nephrologists (46%) or surgeons (43%). Among responding programs, 67% currently transplant DHCV antibody+/NAT- organs under a clinical protocol or as standard of care. By comparison, only 58% offer DHCV NAT+ kidney transplant to HCV- recipients, including 35% under clinical protocols, 14% as standard of care, and 9% under research protocols. Following transplant of DHCV NAT+ organs to uninfected recipients, 53% start direct acting antiviral agent (DAA) therapy after discharge and documented viremia. Viral monitoring protocols after DHCV NAT+ to HCV uninfected recipient kidney transplantation varied substantially. 56% of programs performing these transplants report having an institutional plan to provide DAA treatment if declined by the recipient's insurance. Respondents felt a mean decrease in waiting time of ≥18 months (range 0-60) justifies the practice. Program concerns related to use of DHCV NAT+ kidneys include insurance coverage concerns (72%), cost (60%), and perceived risk of transmitting resistant infection (44%). CONCLUSIONS: Addressing knowledge about safety and logistical/financial barriers related to use of DHCV NAT+ kidney transplantation for HCV uninfected recipients may help reduced discards and expand the organ supply.
BACKGROUND: Transplant practices related to use of organs from Hepatitis C virus infected donors (DHCV+) is evolving rapidly. METHODS: We surveyed U.S. kidney transplant programs by email and professional society listserv postings between 7/19-1/20 to assess attitudes, management strategies, and barriers related to use of viremic (nucleic acid testing (NAT)+) donor organs in HCV uninfected recipients. RESULTS: Staff at 112 unique programs responded, representing 54% of U.S. adult kidney transplant programs and 69% of adult deceased donor kidney transplant volume in 2019. Most survey respondents were transplant nephrologists (46%) or surgeons (43%). Among responding programs, 67% currently transplant DHCV antibody+/NAT- organs under a clinical protocol or as standard of care. By comparison, only 58% offer DHCV NAT+ kidney transplant to HCV- recipients, including 35% under clinical protocols, 14% as standard of care, and 9% under research protocols. Following transplant of DHCV NAT+ organs to uninfected recipients, 53% start direct acting antiviral agent (DAA) therapy after discharge and documented viremia. Viral monitoring protocols after DHCV NAT+ to HCV uninfected recipient kidney transplantation varied substantially. 56% of programs performing these transplants report having an institutional plan to provide DAA treatment if declined by the recipient's insurance. Respondents felt a mean decrease in waiting time of ≥18 months (range 0-60) justifies the practice. Program concerns related to use of DHCV NAT+ kidneys include insurance coverage concerns (72%), cost (60%), and perceived risk of transmitting resistant infection (44%). CONCLUSIONS: Addressing knowledge about safety and logistical/financial barriers related to use of DHCV NAT+ kidney transplantation for HCV uninfected recipients may help reduced discards and expand the organ supply.
Entities:
Keywords:
Direct Acting Antiviral therapy; Donation; Hepatitis C Virus; Infection; Kidney Transplantation; Practices; Survey
Authors: Michael L Volk; Rachel S Tocco; Shawn J Pelletier; Brian J Zikmund-Fisher; Anna S F Lok Journal: Liver Transpl Date: 2011-12 Impact factor: 5.799
Authors: Didier A Mandelbrot; Martha Pavlakis; Seth J Karp; Scott R Johnson; Douglass W Hanto; James R Rodrigue Journal: Transplantation Date: 2009-10-15 Impact factor: 4.939
Authors: David S Goldberg; Peter L Abt; Emily A Blumberg; Vivianna M Van Deerlin; Matthew Levine; K Rajender Reddy; Roy D Bloom; Susanna M Nazarian; Deirdre Sawinski; Paige Porrett; Ali Naji; Richard Hasz; Lawrence Suplee; Jennifer Trofe-Clark; Anna Sicilia; Maureen McCauley; Midhat Farooqi; Caren Gentile; Jennifer Smith; Peter P Reese Journal: N Engl J Med Date: 2017-04-30 Impact factor: 91.245
Authors: D A Axelrod; M A Schnitzler; T Alhamad; F Gordon; R D Bloom; G P Hess; H Xiao; M Nazzal; D L Segev; V R Dharnidharka; A S Naik; N N Lam; R Ouseph; B L Kasiske; C M Durand; K L Lentine Journal: Am J Transplant Date: 2018-05-29 Impact factor: 8.086
Authors: Nae-Yun Heo; Ajitha Mannalithara; Donghee Kim; Prowpanga Udompap; Jane C Tan; W Ray Kim Journal: Transplantation Date: 2018-03 Impact factor: 4.939
Authors: Mark H Eckman; E Steve Woodle; Charuhas V Thakar; Rita R Alloway; Kenneth E Sherman Journal: Am J Kidney Dis Date: 2020-02-17 Impact factor: 8.860
Authors: Nancy Reau; Paul Y Kwo; Susan Rhee; Robert S Brown; Kosh Agarwal; Peter Angus; Edward Gane; Jia-Horng Kao; Parvez S Mantry; David Mutimer; K Rajender Reddy; Tram T Tran; Yiran B Hu; Abhishek Gulati; Preethi Krishnan; Emily O Dumas; Ariel Porcalla; Nancy S Shulman; Wei Liu; Suvajit Samanta; Roger Trinh; Xavier Forns Journal: Hepatology Date: 2018-07-25 Impact factor: 17.425
Authors: Krista L Lentine; Vidya A Fleetwood; Yasar Caliskan; Henry Randall; Jason R Wellen; Melissa Lichtenberger; Craig Dedert; Richard Rothweiler; Gary Marklin; Diane Brockmeier; Mark A Schnitzler; Syed A Husain; Sumit Mohan; Bertram L Kasiske; Matthew Cooper; Roslyn B Mannon; David A Axelrod Journal: Kidney Int Rep Date: 2022-03-28
Authors: Mona D Doshi; Neeraj Singh; Benjamin E Hippen; Kenneth J Woodside; Prince Mohan; Hannah L Byford; Matthew Cooper; Darshana M Dadhania; Sruthi Ainapurapu; Krista L Lentine Journal: Clin J Am Soc Nephrol Date: 2021-10 Impact factor: 10.614
Authors: Beatrice P Concepcion; Laura A Binari; Heidi Schaefer; Scott Rega; Irene Feurer; Saed Shawar; Ruchi Naik; Laura Hickman; Jasmine Walker; Meghan Kapp; Kelly A Birdwell; Anthony Langone; J Harold Helderman; Bonnie Ann Sarrell; Guneet Kochar; Bernard Dubray; Kristin Smith; Heather O'Dell; April DeMers; Princess Shelton; Roman Perri; David Shaffer; Rachel C Forbes Journal: Transplant Direct Date: 2021-09-07
Authors: Zoe A Stewart; Jeffrey Stern; Nicole M Ali; Harmit S Kalia; Karen Khalil; Srijana Jonchhe; Elaina P Weldon; Rebecca A Dieter; Tyler C Lewis; Nur Funches; Sudara Crosby; Monique Seow; Jonathan C Berger; Nabil N Dagher; Bruce E Gelb; Anthony C Watkins; Nader Moazami; Deane E Smith; Zachary N Kon; Stephanie H Chang; Alex Reyentovich; Luis F Angel; Robert A Montgomery; Bonnie E Lonze Journal: Transplant Direct Date: 2021-09-07
Authors: Benjamin E Hippen; David A Axelrod; Kennan Maher; Ruixin Li; Deepali Kumar; Yasar Caliskan; Tarek Alhamad; Mark Schnitzler; Krista L Lentine Journal: Am J Transplant Date: 2022-03-01 Impact factor: 9.369