Nierentransplantationen von Hepatitis-C-infizierten Spendern auf Hepatitis-C-negative Empfänger: Erfahrungen aus dem Transplantationszentrum Marburg
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The persistent shortage of donor organs remains a major challenge in transplant medicine. Waiting times for kidney transplantation are long, and mortality among patients with end-stage renal disease on dialysis remains high. In this context, expanding the donor pool to include hepatitis C (HCV)–positive donors has gained increasing importance. Current evidence demonstrates that the transmission of HCV from positive donors to negative recipients can be effectively prevented through the use of direct-acting antiviral agents (DAAs). However, the optimal timing and duration of antiviral therapy after transplantation remain unclear, and delays in initiating therapy may promote viral reactivation. Administrative and financial barriers within healthcare systems can further complicate treatment initiation. This retrospective study analyzed all kidney transplants performed at the University Hospital Marburg between January 1972 and January 2024 in which kidneys from HCV-positive donors were transplanted into HCV-negative recipients. The primary focus was on post-transplant safety and graft function, comparing recipients of HCV RNA–positive versus HCV antibody–positive donor organs. Data on antibody-positive donors remain limited. Recipients of HCV RNA– positive organs received antiviral therapy, while recipients of antibody-positive organs did not. A total of 1,383 kidney transplants were evaluated. Five patients received kidneys from HCV RNA–positive donors and eight from HCV antibody–positive donors. All RNA-positive recipients were treated with Glecaprevir/Pibrentasvir for twelve weeks following transplantation. One year after transplantation, both groups showed satisfactory graft function as measured by serum creatinine, with no clinically significant proteinuria detected. No patient ever showed detectable HCV RNA, confirming the efficacy of preemptive antiviral therapy. No hepatic complications, systemic inflammatory reactions, or adverse effects related to antiviral therapy occurred. Recipients of HCV antibody–positive organs also showed no HCV infections or reactivations despite the absence of antiviral therapy. Notably, patients who received kidneys from HCV RNA–positive donors experienced significantly shorter waiting times compared to those receiving organs from antibody-positive donors, highlighting the benefit of using HCV RNA–positive grafts. Our findings support existing evidence that kidney transplantation from HCV RNA–positive donors to HCV-negative recipients is safe when immediate, pangenotypic antiviral therapy is initiated. This approach reliably prevents
viral transmission and avoids complications associated with delayed therapy initiation. Transplantation of HCV antibody–positive organs without antiviral therapy appears safe under close laboratory monitoring. These results emphasize the potential of HCV-positive organ transplantation to safely expand the donor pool, reduce waiting times, and improve access to kidney transplantation for patients with end-stage renal disease.
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Issued: 2026-04-15
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FB20:Medizin
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de
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Hepatitis CNierentransplantationChronische Niereninsuffizienz
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lütke Elshoff, Philipp: Nierentransplantationen von Hepatitis-C-infizierten Spendern auf Hepatitis-C-negative Empfänger: Erfahrungen aus dem Transplantationszentrum Marburg. : 2026-04-15.
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Except where otherwised noted, this item's license is described as Attribution 4.0 International