1
|
Forbes RC, Concepcion BP, Clapper D, DuBray BJ, Shawar S, Schaefer HM, Langone A, Shaffer D, Johnson K. The effect of pulsatile pump perfusion on hepatitis C transmission in kidney transplantation: A prospective pilot study. Clin Transplant 2020; 34:e13987. [PMID: 32441791 DOI: 10.1111/ctr.13987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/15/2020] [Indexed: 11/30/2022]
Abstract
With increasing utilization of hepatitis C (HCV) viremic donor organs, there may be a role for kidney pump perfusion to reduce viral load and prevent HCV transmission. We performed a prospective pilot study of HCV viremic donors; one kidney from each donor pair was pumped with perfusate exchanges and viral load testing at least every 4 hours. Donor, recipient, and transplant characteristics were obtained with clinical outcomes. Linear regression was performed to quantify the association between pump time and perfusate viral load. Six HCV viremic donors for six pairs of aviremic recipients were included. Perfusate of the pumped kidneys showed detectable virus throughout the pump cycles. Although perfusate viral levels decreased with increasing pump times, this was not statistically significant (β = -.48, P = .36). All recipients had detectable HCV RNA postoperatively. The pumped cohort had an insignificantly reduced mean viral load compared to pumped recipients (1352 ± 2006 vs 26 170 ± 61 211, P = .09). Time to initiation of direct-acting antiviral was 32 ± 12 vs 26 ± 7 days (P = .17) and to undetectable levels was 66 ± 27 vs 55 ± 22 days (P = .82) for the pumped and unpumped cohorts, respectively. Pulsatile perfusion alone does not appear adequate to decrease HCV transmission. Future studies will need to explore additional ex vivo interventions to pumping.
Collapse
Affiliation(s)
- Rachel C Forbes
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Deana Clapper
- Tennessee Donor Services, Dialysis Clinics, Inc., Nashville, TN, USA
| | - Bernard J DuBray
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Saed Shawar
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Heidi M Schaefer
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anthony Langone
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David Shaffer
- Tennessee Donor Services, Dialysis Clinics, Inc., Nashville, TN, USA
| | - Keith Johnson
- Tennessee Donor Services, Dialysis Clinics, Inc., Nashville, TN, USA
| |
Collapse
|