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To acknowledge World Kidney Day, our latest episode of Crisis Point focuses on the stigma surrounding the use of HCV-positive donor kidneys amid the ongoing organ shortage crisis, with the perspective of a pair of experts and an HCV donor kidney recipient.
This is Crisis Point.
Our mini-docuseries has returned, taking a comprehensive look at public health crises affecting the United States today, with global implications tomorrow. If the crisis point is the moment where a crisis will worsen or begin to get better, the question remains: where are we now?
This episode addresses the ongoing organ shortage crisis amid a growing national transplant waitlist with more than 100,000 people currently seeking a transplant – of these patients, nearly 90,000 are waiting for a new kidney. The advent of direct-acting antiviral (DAA) therapy has transformed clinicians’ ability to treat and cure hepatitis C virus (HCV), a byproduct of these advances has been the ability for the safe and effective use of HCV-positive donor kidneys in non-infected transplant recipients.
Published in 2020, the MYTHIC trial set the stage for using HCV-positive donor kidneys and is widely referenced when discussing their safety and efficacy. Preliminary results for 30 kidney transplants from HCV-viremic donors into HCV-negative recipients showed a 100% cure rate, defined as undetectable plasma HCV RNA 12 weeks after completion of an 8-week course of glecaprevir/pibrentasvir initiated in the early post-transplant period. A follow-up study published in 2021 detailed 1-year findings confirmed this cure rate and further detailed the excellent survival and graft function, which occurred with no clinically significant liver disease or HCV-related kidney injury. Though there is a mounting body of evidence supporting the use of these “increased-risk” organs to help combat the organ shortage, a stigma surrounding HCV persists and hinders uptake of these organs.
For further insight, we gathered perspectives from across the spectrum of the decision-making process for the transplantation of an HCV-positive donor kidney: the hepatologist, the nephrologist, and, at the center of it all, the patient undergoing the transplant. The trio discusses patient perception of this topic and what clinicians can do to help ease transplant recipients’ potential hesitancy about accepting an HCV-positive donor kidney, with additional patient perspective about her experience receiving an HCV donor kidney and the recovery process afterward.
Brief descriptions of the speakers featured in this project are provided below:
For more video content, visit our Crisis Point page to see other episodes on improving health equity in eye care, disparities in cardiovascular health, insulin access in the United States, physician burnout across healthcare, and the ongoing obesity crisis.
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