Outcomes After 4-Week Course of Sofosbuvir/Velpatasvir Therapy in Hepatitis C Seronegative Recipients of Kidneys From Hepatitis C Viremic Deceased Donors.

BACKGROUND

Kidney transplantation from hepatitis C virus (HCV) viremic deceased donors into HCV seronegative recipients helps to expand the donor pool. The optimal duration of direct acting antiviral (DAA) prophylaxis remains undefined.

METHODS

We performed a retrospective review of all HCV seronegative adults who received a kidney transplant from an HCV nucleic acid test (NAT) positive deceased donor at the VA Portland Medical Center between September 2017 and March 2025 and were treated with sofosbuvir/velpatasvir (SOF/VEL) prophylaxis for 28 days postoperatively. The primary outcome was sustained virologic response 12 weeks after completion of prophylaxis (initial SVR12). Secondary outcomes at 1 year included HCV treatment success rate, biopsy proven acute rejection (BPAR), delayed graft function (DGF), eGFR, liver enzyme abnormalities, CMV and BK viremia, adverse events, and all-cause mortality.

RESULTS

Fifty patients were included. The mean age was 62.8 ± 10.9 years, 92% were male, mean EPTS was 63.7 ± 29.2 and mean KDPI was 59.8 ± 19.6. Initial SVR12 after completion of prophylaxis was achieved in 46/50 (92%), out of which 2 patients had their SOF/VEL prophylaxis extended to 12 weeks because of transient viremia. Four patients (8%) failed prophylaxis and required HCV treatment with all achieving SVR (100% overall SVR). DGF occurred in 16%, BPAR in 12%, CMV viremia in 18%, and BK viremia in 16%. Mean 1-year eGFR was 57.7 ± 18.7 mL/min/1.73 m2. No DAA attributable adverse events were recorded. One-year all-cause mortality was 2% (1/50) and was unrelated to HCV or DAA. Older age (72.3 ± 4.0 vs. 62.0 ± 11.0 years, p = 0.030) and higher Estimated Post Transplant Survival (EPTS) scores (86.5 ± 19.1 vs. 61.8 ± 29.3, p = 0.041) correlated significantly with prophylaxis failure.

CONCLUSION

A 4-week SOF/VEL prophylaxis regimen coupled with HCV RNA surveillance and treatment appears to be safe and effective in a Veterans Affairs population.