Kidney Transplantation From Hepatitis C Virus-Infected Donors to Uninfected Recipients : A Systematic Review for the KDIGO 2022 Hepatitis C Clinical Practice Guideline Update
Copyright © 2023 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved..
RATIONALE & OBJECTIVE: Direct-acting antiviral (DAA) treatment of hepatitis C virus (HCV) infection in patients with chronic kidney disease (CKD) has made transplantation of kidneys from HCV-infected donors to uninfected recipients (D+/R-) feasible. To facilitate an update to the 2018 KDIGO guideline for patients with CKD and HCV, we conducted a systematic review of HCV D+/R-kidney transplantation coupled with DAA treatment.
STUDY DESIGN: Systematic review and meta-analysis.
SETTING & STUDY POPULATIONS: We included studies of HCV D+/R-kidney transplantations that used any DAA protocol.
SELECTION CRITERIA FOR STUDIES: Based on a search of PubMed, Embase, Cochrane, CINAHL, and ClinicalTrials.gov through February 1, 2022, conferences from 2019 to 2021, and the 2018 KDIGO HCV guideline we identified single-group (D+/R-) or comparative studies of D+/R-versus D-/R-kidney transplantation.
DATA EXTRACTION: Conducted in SRDR-Plus with review by a second researcher.
ANALYTICAL APPROACH: Maximum likelihood meta-analyses; the certainty of evidence was assessed per GRADE (Grading of Recommendations Assessment, Development and Evaluation).
RESULTS: We identified 16 studies (N=557). A sustained viral response at 12 weeks after treatment (SVR12) was observed in 97.7% (95% CI, 96.3%-98.8%). Ultrashort duration treatment (≤8 days) resulted in viremia requiring standard-course DAA treatment in some patients, all of whom achieved SVR12 after 1 or rarely 2 DAA courses. Serious adverse events from DAA treatment were rare after D+/R-transplantation (0.4% [95% CI, 0.1%-2.8%]). At≥1 year after D+/R-transplantation, recipient death occurred in 2.1% (95% CI, 0.9-3.7) and allograft survival was 97.6% (95% CI, 95.7%-98.9%). Estimated glomerular filtration rate 1 year after transplantation ranged from 46 to 74mL/min/1.73m2.
LIMITATIONS: Analyses were generally based on low-certainty evidence. Uncertainty exists about the long-term safety and efficacy of D+/R-transplantation. Few studies investigated ultrashort treatment courses.
CONCLUSIONS: Kidney transplantation from HCV-infected donors to uninfected recipients followed by DAA treatment appears to be safe and associated with excellent 1-year clinical outcomes.
PLAIN-LANGUAGE SUMMARY: Due to the high efficacy of direct-acting antivirals (DAA), the use of kidneys from HCV-infected deceased donors may increase rates of kidney transplantation. We conducted a systematic review for the 2022 KDIGO Clinical Practice Guideline on Hepatitis C to evaluate the safety and efficacy of kidney transplantation from HCV-infected donors to uninfected recipients (D+/R-) followed by DAA therapy. Sixteen studies comprising 557 patients revealed high rates of sustained viral response, low rates of adverse events, and excellent patient and allograft survival 1 year after transplantation. Kidney transplantation from HCV-infected deceased donors to uninfected recipients treated with DAA appears safe and effective. Future studies should investigate shorter treatment durations, monitor safety, and obtain longer-term efficacy data.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:82 |
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| Enthalten in: |
American journal of kidney diseases : the official journal of the National Kidney Foundation - 82(2023), 4 vom: 01. Okt., Seite 410-418 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Gordon, Craig E [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 25.09.2023 Date Revised 12.10.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1053/j.ajkd.2022.12.019 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM355651386 |
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| 100 | 1 | |a Gordon, Craig E |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Kidney Transplantation From Hepatitis C Virus-Infected Donors to Uninfected Recipients |b A Systematic Review for the KDIGO 2022 Hepatitis C Clinical Practice Guideline Update |
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| 500 | |a Date Completed 25.09.2023 | ||
| 500 | |a Date Revised 12.10.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a RATIONALE & OBJECTIVE: Direct-acting antiviral (DAA) treatment of hepatitis C virus (HCV) infection in patients with chronic kidney disease (CKD) has made transplantation of kidneys from HCV-infected donors to uninfected recipients (D+/R-) feasible. To facilitate an update to the 2018 KDIGO guideline for patients with CKD and HCV, we conducted a systematic review of HCV D+/R-kidney transplantation coupled with DAA treatment | ||
| 520 | |a STUDY DESIGN: Systematic review and meta-analysis | ||
| 520 | |a SETTING & STUDY POPULATIONS: We included studies of HCV D+/R-kidney transplantations that used any DAA protocol | ||
| 520 | |a SELECTION CRITERIA FOR STUDIES: Based on a search of PubMed, Embase, Cochrane, CINAHL, and ClinicalTrials.gov through February 1, 2022, conferences from 2019 to 2021, and the 2018 KDIGO HCV guideline we identified single-group (D+/R-) or comparative studies of D+/R-versus D-/R-kidney transplantation | ||
| 520 | |a DATA EXTRACTION: Conducted in SRDR-Plus with review by a second researcher | ||
| 520 | |a ANALYTICAL APPROACH: Maximum likelihood meta-analyses; the certainty of evidence was assessed per GRADE (Grading of Recommendations Assessment, Development and Evaluation) | ||
| 520 | |a RESULTS: We identified 16 studies (N=557). A sustained viral response at 12 weeks after treatment (SVR12) was observed in 97.7% (95% CI, 96.3%-98.8%). Ultrashort duration treatment (≤8 days) resulted in viremia requiring standard-course DAA treatment in some patients, all of whom achieved SVR12 after 1 or rarely 2 DAA courses. Serious adverse events from DAA treatment were rare after D+/R-transplantation (0.4% [95% CI, 0.1%-2.8%]). At≥1 year after D+/R-transplantation, recipient death occurred in 2.1% (95% CI, 0.9-3.7) and allograft survival was 97.6% (95% CI, 95.7%-98.9%). Estimated glomerular filtration rate 1 year after transplantation ranged from 46 to 74mL/min/1.73m2 | ||
| 520 | |a LIMITATIONS: Analyses were generally based on low-certainty evidence. Uncertainty exists about the long-term safety and efficacy of D+/R-transplantation. Few studies investigated ultrashort treatment courses | ||
| 520 | |a CONCLUSIONS: Kidney transplantation from HCV-infected donors to uninfected recipients followed by DAA treatment appears to be safe and associated with excellent 1-year clinical outcomes | ||
| 520 | |a PLAIN-LANGUAGE SUMMARY: Due to the high efficacy of direct-acting antivirals (DAA), the use of kidneys from HCV-infected deceased donors may increase rates of kidney transplantation. We conducted a systematic review for the 2022 KDIGO Clinical Practice Guideline on Hepatitis C to evaluate the safety and efficacy of kidney transplantation from HCV-infected donors to uninfected recipients (D+/R-) followed by DAA therapy. Sixteen studies comprising 557 patients revealed high rates of sustained viral response, low rates of adverse events, and excellent patient and allograft survival 1 year after transplantation. Kidney transplantation from HCV-infected deceased donors to uninfected recipients treated with DAA appears safe and effective. Future studies should investigate shorter treatment durations, monitor safety, and obtain longer-term efficacy data | ||
| 650 | 4 | |a Meta-Analysis | |
| 650 | 4 | |a Systematic Review | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Chronic kidney disease | |
| 650 | 4 | |a direct-acting antivirals | |
| 650 | 4 | |a hepatitis C | |
| 650 | 4 | |a kidney transplantation systematic review | |
| 650 | 4 | |a meta-analysis | |
| 650 | 7 | |a Antiviral Agents |2 NLM | |
| 700 | 1 | |a Adam, Gaelen P |e verfasserin |4 aut | |
| 700 | 1 | |a Jadoul, Michel |e verfasserin |4 aut | |
| 700 | 1 | |a Martin, Paul |e verfasserin |4 aut | |
| 700 | 1 | |a Balk, Ethan M |e verfasserin |4 aut | |
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