THINKER-NEXT

The Transplanting Hepatitis C Kidneys into Negative KidnEy Recipients [THINKER-NEXT] study will include adult kidney transplant candidates without hepatitis C virus (HCV) infection on the transplant waiting list who will consent to kidney transplantation from a deceased donor infected with HCV, followed by treatment with a direct acting antiviral. The one-year allograft function and one-year risk of CMV infection will be compared between THINKER-NEXT kidney transplant recipients and matched recipients who received hepatitis C uninfected kidney transplants (these patients are called Transplant Cohort). The survival rate of patients opting-in for offers of kidneys from HCV-viremic donors will be compared to the survival rate of matched comparators from the kidney transplant waitlist who did not consent to receive offers of a HCV-viremic kidney. Lastly, renal pathologic findings will be compared among HCV-viremic donors and HCV-negative comparator donors.

Inclusion Criteria:

• Able to provide informed consent

• Active waiting list status for isolated kidney transplant

• 18 years of age or older

• No living kidney donor

• Panel reactive antibody (PRA) ≤97% (most recent cPRA at time of screening). Patients with a PRA of 98-100% at screening can be included unless patient has a most recent cytotoxic PRA of >25% or calculated PRA >50% where multiple moderate level HLA antibodies exist and in the opinion of the local site investigator represents substantial HLA sensitization. If patient has a PRA of 98-100%, the donor-recipient pair must meet additional eligibility criteria.

Exclusion Criteria:

• Hepatocellular carcinoma

• Hepatitis B surface antigen and/or DNA positive

• Active Hepatitis C infection

• HIV RNA-positive or HIV antibody positive

• Other chronic liver disease (excluding non-alcoholic fatty liver disease [NAFLD] with normal liver enzymes)

• Persistently elevated liver transaminases (defined as the upper limit of normal at the reference laboratory)

• Advanced hepatic fibrosis or cirrhosis

• Primary Focal Segmental Glomerulosclerosis (FSGS), FSGS recurring in initial transplant, or other disease process at high risk of early graft failure per the treating transplant nephrologist

• Current use of amiodarone or dronedarone (due to interaction with sofosbuvir)

• Transplant candidate requires antibody desensitization protocol for transplantation

• Female who is pregnant, planning to become pregnant during the study, or breast-feeding

• Participation in another interventional study, from a period starting 6 months prior to screening to last study visit, that the study PIs judge would interfere with either the aims or the safety of the THINKER-NEXT study.