Background: With the development of direct-acting antiviral agents (DAAs), the research on kidney transplantation from Hepatitis C virus (HCV)-viremic donors to HCV-negative recipients has grown. The objective of this comprehensive analysis was to evaluate the efficacy and safety of DAAs in kidney transplantation from HCV-viremic donors to negative recipients. Methods: Multiple databases were searched for a systematic and comprehensive up
to March 2022. The primary outcomes included the percentage of sustained virological response at week 12 after the end of treatment (SVR12), adverse events (AEs; any grade), and severe adverse events (SAEs) as the endpoints. Publication bias was examined by using the funnel plots and Egger's test. Results: In total, 16 studies with 454 subjects were included in the study and the pooled estimate of SVR12, AEs, and SAEs rates were 100.0% (95% CI: 99.2-100.0), 1.9%(95%CI: 0.0-4.9), and 0.0% (95%CI: 0.0-1.5). Subgroup analysis showed that pooled SVR12 rates were 100.0% (95%CI: 99.6-100.0) for genotype (GT)1a and 96.3% (95%CI: 83.3-100.0) for GT2; 100.0% (95%CI: 98.9-100.0) for DAAs treatments; and 100.0% (95%CI: 98.2-100.0) for prophylaxis subgroup. Egger's tests showed that no publication bias was found in this study. Conclusion: This comprehensive analysis showed the high efficacy and safety of DAAs in kidney transplantation from HCV-viremic donors to HCV-negative recipients. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=246541.
Mr Simon Knight, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford
This systematic review and meta-analysis summarises the literature on the use of direct-acting antivirals (DAAs) in kidney transplant recipients undergoing transplant from a HCV positive donor. The authors identify 16 studies in 454 recipients. Pooled analysis showed a sustained virological response at week 12 of 100%. Rate of adverse events was found to be 1.9%, with no patients experiencing serious adverse events related to DAAs. The authors conclude that DAAs are highly effective and safe for use in this patient population. Methodology appears sound, with a comprehensive search strategy undertaken by 2 reviewers across a number of databases and
comprehensive risk of bias assessment undertaken. Studies were all non-randomised or observational in nature, but assessed to have a relatively low risk of bias overall. Given the non-randomised nature of the included studies, use of a fixed-effects analysis is questionable but given the lack of heterogeneity is unlikely to impact the findings significantly.
The aim of this study was to assess the efficacy and safety of direct-acting antiviral agents (DAAs) in renal transplantation from hepatitis C virus (HCV) positive donors to HCV negative recipients.
Electronic databases including PubMed, Embase, and Web of Science were searched. Study selection and data extraction were performed by two independent reviewers. The Methodological Index for Non-Randomized Studies (MINORS) was used to assess the methodological quality of the included studies.
16 studies were included in the meta-analysis.
The primary endpoint was the percentage of sustained virological response at week 12 post-treatment (SVR12). The secondary endpoints included the percentages of HCV transmission from donors to recipients, adverse events, and severe adverse events (SAEs).