Two weeks of prophylaxis after kidney transplant may prevent hepatitis C

Short-term prophylaxis with direct-acting antivirals is completely effective in protecting kidney transplant recipients when the donor has hepatitis C, a proof-of-concept study shows.

Christine Durand, MD, of the Johns Hopkins University School of Medicine in Baltimore, and colleagues found that a 2-week course of prophylactic treatment prevented infection in all 10 negative recipients of positive donor kidneys in this small, uncontrolled trial. Hepatitis C.

Only one of the 10 patients had transient liver function abnormalities in the laboratory within 12 weeks of transplantation, the researchers said in a report. Annals of Internal Medicine Short report.

“Our data show that if hepatitis C treatment is started before transplantation to prevent infection in the recipient, the duration of treatment can be as short as 2 weeks, rather than 8 or 12 weeks to cure the infection,” Durand said. Today’s Medicine Page. “This means fewer medications for patients and lower costs for patients and the health system.”

“We believe it is better to prevent infection rather than wait for treatment after transmission,” she added, referring to the typical approach to transmission and treatment, which is to give direct-acting antiviral drugs after transplantation. Although transmission and treatment are effective in curing hepatitis C infection, it may result in donor-specific antibodies, rejection, BK polyomavirus and cytomegalovirus viremia, and severe fibrotic cholestatic hepatitis C in some recipients .

The researchers also noted that preventive treatment is less costly than a full course of treatment. Some previous studies have also evaluated direct-acting antiviral prophylaxis, but it was unclear what the optimal duration was. The research team previously achieved 100% efficacy with 12-week and 4-week treatment courses. Other studies of treatment courses of seven days or less noted transmission rates from 4% to 30%, as well as antiviral resistance.

There were no rejection episodes and no deaths in the current trial. The median estimated glomerular filtration rate (eGFR) of functional grafts was 46 mL/min/1.73 m² Week 12, 62 mL/min/1.73 m² Year 1, 58mL/min/1.73m² In year 2.

Ten transplant recipients (median age 60 years) received one dose of glecaprevir 300 mg-pibrentasvir 120 mg (Mavyret) prophylaxis before kidney transplantation and subsequently received 13 additional once-daily doses after transplantation. Standard immunosuppression was induced with antithymocyte globulin, followed by tacrolimus, mycophenolate mofetil, and prednisone.

All recipients were 18 years of age or older, had negative hepatitis C RNA results, and did not have HIV or active hepatitis B. All deceased donors were between 13 and 60 years old, had positive hepatitis C RNA results, terminal creatinine less than 10 mg/dL (884 μmol/L), and no chronic changes in renal biopsies. The kidney transplants were performed at Johns Hopkins University from November 2020 to August 2021, and the recipients were followed for 2 years.

During the first week of prophylaxis after transplantation, 8 of 10 recipients developed low-level hepatitis C viremia. At week 12, all patients had hepatitis C RNA below the lower limit of quantitation (the primary efficacy endpoint). On postoperative day 5, a liver transplant recipient developed grade 3 bilirubin elevation that resolved by day 9. This recipient also experienced elevated liver enzymes on postoperative day 28, which resolved by day 40.

Another recipient’s post-kidney transplant eGFR was consistently less than 10 mL/min/1.73 m² Graft failure occurred at 4.5 months. Biopsy showed severe tubulointerstitial scarring of unknown origin but no evidence of hepatitis C-related kidney disease.

“Stay tuned for results from PREVENT-HCV, a larger study that directly compares this two-week prevention approach with waiting to treat after transmission,” Durand said. The trial is ongoing and is expected to It will be completed in March 2027.