In Hepatitis C Virus-Negative Recipients of a Hepatitis C Virus-Infected Donor Kidney, Direct Antiviral Agent Therapy for 8 Weeks Is Noninferior to 12 Weeks.

The current recommended duration of 12 weeks of post-transplantation hepatitis C virus (HCV) treatment for HCV-uninfected recipients of HCV-infected kidneys (HCV D+/R-) is based on limited data. In March 2020, the transplant center's HCV-treatment protocol was revised by reducing the duration of treatment for glecaprevir/pibrentasvir from 12 weeks to 8 weeks, thus creating a natural experiment to compare sustained virologic response (SVR) rates between the 2 treatment groups. We analyzed HCV treatment outcomes of HCV D+/R- kidney recipients between October 2018 and July 2022 at a single transplant center in all patients treated with glecaprevir/pibrentasvir after kidney transplantation. Fifty-five patients were treated for 12 weeks, and 24 patients were treated for 8 weeks. In the 12-week group, 2 patients died of non-HCV causes after the end of treatment, before SVR; both were aviremic at the end of treatment. The remaining 53 patients achieved SVR. All 24 patients in the 8-week group achieved SVR. The median time to treatment initiation was 14 days (range, 3-138 days) for the 12-week group and 15 days (range, 5-81 days) for the 8-week group (P = .72). Even though most patients started treatment after the first week post-transplantation, 8 weeks of glecaprevir/pibrentasvir was equally effective as 12 weeks of treatment in achieving SVR for HCV D+/R- kidney recipients.