{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:17:24Z","timestamp":1787019444298,"version":"build-2736575974"},"reference-count":39,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Flynn Family Chair in Renal Transplantation"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Can J Kidney Health Dis"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose of program:<\/jats:title>\n                    <jats:p>The ongoing shortage of organs for transplant combined with Manitoba having the highest prevalence of end-stage renal disease (ESRD) in Canada has resulted in long wait times on the deceased donor waitlist. Therefore, the Transplant Manitoba Adult Kidney Program has ongoing quality improvement initiatives to expand the deceased donor pool. This clinical transplant protocol describes the use of prophylactic pan-genotypic direct-acting anti-viral agents (DAA) for transplanting hepatitis C (HCV)-viremic kidneys (HCV antibody positive\/nucleic acid [nucleic acid amplification testing, NAT] positive) to HCV-na\u00efve recipients as routine standard of care. We will evaluate the provincial implementation of this protocol as a prospective observational cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Sources of information:<\/jats:title>\n                    <jats:p>Scoping literature review and key stakeholder engagement with interdisciplinary health care providers and health system leaders\/decision markers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Patients will be screened pre-transplant for eligibility and undergo a multilevel education and consent process to participate in this expanded donor program. Incident adult HCV-na\u00efve recipients of an HCV-viremic kidney transplant will be treated prophylactically with glecaprevir-pibrentasvir with the first dose administered on call to the operation. Glecaprevir-pibrentasvir will be used for 8 weeks with viral monitoring and hepatology follow-up. Primary outcomes are sustained virologic response (SVR) at 12 weeks and the tolerability of DAA therapy. Secondary outcomes within the first year post-transplant are patient and graft survival, graft function, biopsy-proven rejection, HCV transmission to recipient (HCV NAT positive), and HCV nonstructural protein 5A (NS5A) resistance. Safety outcomes within the first year post-transplant include fibrosing cholestatic hepatitis, acute liver failure, primary and secondary DAA treatment failure, HCV transmission to a recipient\u2019s partner, elevated liver enzymes \u22652-fold, abnormal international normalized ratio (INR), angioedema, anaphylaxis, cirrhosis, and hepatocellular carcinoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key findings:<\/jats:title>\n                    <jats:p>This program successfully advocated for and obtained hospital formulary, provincial Exceptional Drug Status (EDS), and Non-Insured Health Benefits (NIHB) to provide prophylactic DAA therapy for this indication, and this information may be useful to other provincial transplant organizations seeking to establish an HCV-viremic kidney transplant program with prophylactic DAA drug coverage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Limitations:<\/jats:title>\n                    <jats:p>(1) Patient engagement was not undertaken during the program design phase, but patient-reported experience measures will be obtained for continuous quality improvement. (2) Only standard criteria donors (optimal kidney donor profile index [KDPI] \u226460) will be used. If this approach is safe and feasible, then higher KDPI donors may be included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications:<\/jats:title>\n                    <jats:p>The goal of this quality improvement project is to improve access to kidney transplantation for Manitobans. This program will provide prophylactic DAA therapy for HCV-viremic kidney transplant to HCV-na\u00efve recipients as routine standard of care outside a clinical trial protocol. We anticipate this program will be a safe and effective way to expand kidney transplantation from a previously unutilized donor pool.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20543581211033496","type":"journal-article","created":{"date-parts":[[2021,7,26]],"date-time":"2021-07-26T07:11:31Z","timestamp":1627283491000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Expanding the Deceased Donor Pool in Manitoba Using Hepatitis C-Viremic Donors: Program Report"],"prefix":"10.1177","volume":"8","author":[{"given":"Susan","family":"Cuvelier","sequence":"first","affiliation":[{"name":"Section of Hepatology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Van Caeseele","sequence":"additional","affiliation":[{"name":"Cadham Provincial Laboratory, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1119-9724","authenticated-orcid":false,"given":"Matthew","family":"Kadatz","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8234-1823","authenticated-orcid":false,"given":"Kathryn","family":"Peterson","sequence":"additional","affiliation":[{"name":"Transplant Manitoba Adult Kidney Program, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siyao","family":"Sun","sequence":"additional","affiliation":[{"name":"Transplant Manitoba Adult Kidney Program, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Dodd","sequence":"additional","affiliation":[{"name":"Transplant Manitoba Adult Kidney Program, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim","family":"Werestiuk","sequence":"additional","affiliation":[{"name":"Transplant Manitoba Adult Kidney Program, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Koulack","sequence":"additional","affiliation":[{"name":"Section of Vascular Surgery, Department of Surgery, University of Manitoba, Winnipeg, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Nickerson","sequence":"additional","affiliation":[{"name":"Transplant Manitoba Adult Kidney Program, Winnipeg, Manitoba, Canada"},{"name":"Section of Nephrology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada"},{"name":"Department of Immunology, University of Manitoba, Winnipeg, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8342-9093","authenticated-orcid":false,"given":"Julie","family":"Ho","sequence":"additional","affiliation":[{"name":"Transplant Manitoba Adult Kidney Program, Winnipeg, Manitoba, Canada"},{"name":"Section of Nephrology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada"},{"name":"Department of Immunology, University of Manitoba, Winnipeg, 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