Successful early sofosbuvir‐based antiviral treatment after transplantation of kidneys from HCV‐viremic donors into HCV‐negative recipients

Background Transplanting kidneys from deceased donors with hepatitis C virus (HCV) viremia has been controversial for some time. Direct‐acting antiviral agents have been shown to be highly effective in treating HCV infection. We report our experience with transplanting kidneys from HCV‐positive donors with detectable viremia into HCV‐negative recipients, followed by early treatment with a sofosbuvir‐based antiviral regimen. Methods Data were collected from seven HCV‐negative recipients receiving kidneys from five deceased HCV‐viremic donors. Before transplantation, all intentional transplanted recipients had given informed consent regarding the acceptance of an HCV‐viremic kidney. Recipients were closely monitored after transplant with measurements of HCV viremia, liver and renal function, and trough levels of immunosuppressive drugs. Results Four donors were infected with HCV genotype 1; the other with HCV genotype 3a. HCV viremia was detectable in all seven renal transplant recipients within 3 days after transplant. After determination of HCV genotype, antiviral treatment with a sofosbuvir‐based regimen (sofosbuvir/ledipasvir, n = 4; sofosbuvir/velpatasvir, n = 3) was initiated within a median of 7 days after transplantation and was continued for 8 to 12 weeks. For all recipients, viral load was below the level of detection at the end of treatment, and all exhibited a sustained virologic response 12 weeks later. All recipients exhibited normal liver enzyme activity at the end of treatment. Renal allograft function and trough levels of tacrolimus remained stable. Conclusions Early administration of a sofosbuvir‐based regimen to HCV‐negative recipients of kidneys from HCV‐viremic donors is feasible and safe. The definition of an optimal therapeutic approach warrants further investigation.