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Updated: Oct 3, 2025
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
One-Year Outcomes of the Multi-Center StudY to Transplant Hepatitis C-InfeCted kidneys (MYTHIC) Trial
Meghan Elizabeth Sise1, David Seth Goldberg2, Douglas Earl Schaubel3
1Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
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.
Insights
Transplanting kidneys from hepatitis C virus (HCV) viremic donors significantly increases kidney transplant (KT) probability. Patients receiving HCV-viremic kidneys show excellent 1-year outcomes, including high survival and graft function, with all achieving HCV cure.
Area of Science:
- Nephrology
- Hepatology
- Transplantation Immunology
Background:
- Hepatitis C virus (HCV) viremic donor kidney transplantation into HCV-negative recipients is increasingly used.
- Limited data exist from single centers with short-term follow-up.
Purpose of the Study:
- To evaluate the outcomes of HCV viremic donor kidney transplantation in a multicenter trial.
- To compare kidney transplant rates and safety outcomes against waitlist comparators.
Main Methods:
- The MYTHIC study enrolled 63 patients undergoing kidney transplantation (KT) from HCV viremic donors.
- Recipients received 8 weeks of glecaprevir/pibrentasvir (G/P) post-KT.
- Outcomes included KT probability, safety, graft function, and survival at 1 year.
Main Results:
- The MYTHIC cohort had a 3.5-fold higher 1-year KT incidence (68%) versus waitlist comparators (19%).
- All 30 HCV-viremic KT recipients achieved HCV cure with no significant liver disease or HCV-related kidney injury.
- 1-year survival was 93% with excellent graft function (median creatinine 1.17 mg/dl).
Conclusions:
- Opting for HCV-viremic donor kidneys increases KT probability and offers excellent 1-year outcomes.
- This multicenter trial supports the use of HCV-viremic kidneys in transplantation.
- Further monitoring for complications like CMV disease is warranted.
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