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Pathological Consequences in Anti-HCV Antibody-Positive Organ Donation to an Anti-HCV Antibody-Negative Recipient
Anna Rossetto1, Gian Luigi Adani2, Umberto Baccarani3
1General Surgery Unit, Area Medical Department, University of Udine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
Insights
Hepatitis C virus (HCV) positive organ donation is now viable with antiviral therapies. However, ongoing or past HCV infection and antibodies can cause kidney damage, necessitating careful risk management in transplantation.
Area of Science:
- Transplantation immunology
- Hepatology
- Nephrology
Background:
- Expanding organ donor pools necessitates using marginal organs, including those from hepatitis C virus (HCV)-positive donors.
- Antiviral therapies have made transplantation from HCV-positive and even viremic donors a possibility.
Purpose of the Study:
- To review literature on kidney transplantation from HCV-positive donors, focusing on potential long-term renal damage.
- To understand antibody development and immunity transmission in HCV-positive to HCV-negative antibody donor transplantation.
- To assess the efficacy of pre- or post-transplant antiviral therapy in HCV-seronegative recipients from HCV-infected donors.
Main Methods:
- Literature review focusing on kidney transplantation outcomes.
- Analysis of antibody development and seroconversion patterns in recipients.
- Evaluation of antiviral therapy protocols and their impact on sustained response.
Main Results:
- HCV infection (current or past) and HCV antibodies alone can lead to kidney damage.
- Antiviral therapy administered to recipients before or shortly after transplantation achieves high rates of sustained response.
- The development and disappearance of anti-HCV antibodies vary by organ and time, with unclear mechanisms.
Conclusions:
- Direct-acting antiviral (DAA) therapy has transformed HCV treatment and transplantation possibilities.
- Understanding HCV pathophysiology is crucial for minimizing infection transmission and viremia risk in transplant recipients.
- Vigilance regarding HCV-related renal damage is advised, especially for patients with long life expectancies, employing all available strategies.
Background:
The need to expand the pool of available organs for transplantation has meant that the use of marginal organs is increasingly widespread. The advent of antiviral therapy for hepatitis C virus (HCV) has made it possible to consider the donation of organs from HCV-positive donors and even from viremic donors.
Methods:
In HCV-positive to HCV-negative antibody donor transplantation, the development of antibodies to HCV is uneven, depending on the organ transplanted and with differences in the time of appearance. Whether the subsequent disappearance is attributed to the development of antibodies or the transmission of immunity between donor and recipient remains unclear. In transplantation from an HCV-infected donor to a HCV-seronegative recipient, the administration of antiviral therapy to the recipient before transplantation or a few days after transplantation achieves sustained response in almost all cases. We wanted to deepen the argument by studying the data in the literature, focusing on kidney transplantation, considering that this could be of interest, particularly for possible long-term renal damage.
Results:
HCV infection both ongoing and previous, as well as the presence of HCV antibodies alone, can be responsible for kidney damage.
Conclusions:
Direct-acting anti-HCV therapy has revolutionized the treatment of HCV disease and the therapeutic possibilities of transplantation. However, we believe it is useful to keep in mind the pathophysiology of HCV-related damage especially in patients with a long life expectancy, using all emerging strategies to minimize the risk of transmission of infection or development of viremia.
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