One-Year Outcomes of the Multicenter Study to Transplant Hepatitis C-Infected Kidneys Trial

Meghan Elizabeth Sise, David Seth Goldberg, Douglas Earl Schaubel, Robert J. Fontana, Jens J. Kort, Rita R. Alloway, Christine M. Durand, Emily A. Blumberg, E. Steve Woodle, Kenneth E. Sherman, Robert S. Brown, John J. Friedewald, Niraj M. Desai, Samuel T. Sultan, Josh Levitsky, Meghan D. Lee, Ian A. Strohbehn, J. Richard Landis, Melissa Fernando, Jenna L. GustafsonRaymond T. Chung*, Peter Philip Reese

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Transplanting kidneys from hepatitis C virus (HCV) viremic donors into HCV-negative patients (HCV D-RNA-positive/R-negative) has evolved from experimental to “standard-of-care” at many centers. Nevertheless, most data derive from single centers and provide only short-term follow-up. Methods: The Multicenter Study to Transplant Hepatitis C-Infected Kidneys (MYTHIC) study was a multicenter (7 sites) trial of HCV D-RNA-positive/R-negative kidney transplantation (KT) followed by 8 weeks of glecaprevir/pibrentasvir (G/P) initiated 2 to 5 days post-KT. Prespecified outcomes included probability of KT (vs. matched waitlist comparators) and 1-year safety outcomes, allograft function, and survival. Results: Among 63 enrolled patients, 1-year cumulative incidence of KT was approximately 3.5-fold greater for the MYTHIC cohort versus 2055 matched United Network for Organ Sharing (UNOS) comparators who did not opt-in to receive a kidney from an HCV-viremic donor (68% vs. 19%, P < 0.0001). Of 30 HCV D-RNA-positive/R-negative KT recipients, all achieved HCV cure. None developed clinically significant liver disease or HCV-related kidney injury. Furthermore, 1-year survival was 93% and 1-year graft function was excellent (median creatinine 1.17; interquartile range [IQR]: 1.02–1.38 mg/dl). There were 4 cases of cytomegalovirus (CMV) disease among 10 CMV-negative patients transplanted with a kidney from an HCV-viremic/CMV-positive donor. Conclusion: The 1-year findings from this multicenter trial suggest that opting-in for HCV-viremic KT offers can increase probability of KT with excellent 1-year outcomes. Trial Registration: NCT03781726

Original languageEnglish (US)
JournalKidney International Reports
DOIs
StateAccepted/In press - 2021

Keywords

  • cytomegalovirus infection
  • direct-acting antivirals
  • glecaprevir/pibrentasvir
  • hepatitis C virus
  • kidney transplantation
  • organ allocation

ASJC Scopus subject areas

  • Nephrology

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