Bekir Tanriover

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Journals/Publications

• Rychlik, M., Tanriover, B., & Han, Y. (2024). Large-scale data extraction from the UNOS organ donor documents.
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  In this paper we focus on three major task: 1) discussing our methods: Ourmethod captures a portion of the data in DCD flowsheets, kidney perfusion data,and Flowsheet data captured peri-organ recovery surgery. 2) demonstrating theresult: We built a comprehensive, analyzable database from 2022 OPTN data. Thisdataset is by far larger than any previously available even in this preliminaryphase; and 3) proving that our methods can be extended to all the past OPTNdata and future data. The scope of our study is all Organ Procurement and Transplantation Network(OPTN) data of the USA organ donors since 2008. The data was not analyzable ina large scale in the past because it was captured in PDF documents known as``Attachments'', whereby every donor's information was recorded into dozens ofPDF documents in heterogeneous formats. To make the data analyzable, one needsto convert the content inside these PDFs to an analyzable data format, such asa standard SQL database. In this paper we will focus on 2022 OPTN data, whichconsists of $\approx 400,000$ PDF documents spanning millions of pages. Theentire OPTN data covers 15 years (2008--20022). This paper assumes that readersare familiar with the content of the OPTN data.[Journal_ref: ]
• Al-Obaidi, M. M., Gungor, A. B., Murugapandian, S., Thajudeen, B., Mansour, I., Wong, R. C., Tanriover, B., & Zangeneh, T. T. (2023). The Impact of Nirmatrelvir-Ritonavir in Reducing Hospitalizations Among High-Risk Patients With SARS-CoV-2 During the Omicron Predominant Era. The American journal of medicine, 136(6), 577-584.
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  The coronavirus disease 2019 (COVID-19) pandemic has caused significant morbidity and mortality in high-risk populations. Several therapeutics have been developed to reduce the risk of complications related to COVID-19, hospitalizations, and death. In several studies, nirmatrelvir-ritonavir (NR) was reported to reduce the risk of hospitalizations and death. We aimed to evaluate the efficacy of NR in preventing hospitalizations and death during the Omicron predominant period.
• Mansour, I., Murugapandian, S., Tanriover, B., & Thajudeen, B. (2023). Contemporary Monoclonal Antibody Utilization in Glomerular Diseases. Mayo Clinic proceedings. Innovations, quality & outcomes, 7(4), 276-290.
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  Therapeutic monoclonal antibodies (MAbs) have been one of the fastest growing drug classes in the past 2 decades and are indicated in the treatment of cancer, autoimmune disorders, solid organ transplantation, and glomerular diseases. The Food and Drug Administration has approved 100 MAbs between 1986 and 2021, and MAbs account for 20% of Food and Drug Administration's new drug approval every year. MAbs are preferred over traditional immunosuppressive agents because of their high specificity, reduced number of drug-drug interactions, and low toxicity, which make them a prime example of personalized medicine. In this review article, we provide an overview of the taxonomy, pharmacology, and therapeutic applications of MAbs in glomerular diseases. We searched the literature through PubMed using the following search terms: , and limited our search to years 2018-2023. We selected peer-reviewed journal articles with an evidence-based approach, prioritizing randomized control trials in specific glomerular diseases, if available. Advances in the MAb field have resulted in a significant paradigm shift in targeted treatment of immune-mediated glomerular diseases, and multiple randomized control trials are currently being conducted. Increased recognition is critical to expand their use in experimental research and personalized medicine.
• Sridhara, S., Gungor, A. B., Erol, H. K., Al-Obaidi, M., Zangeneh, T. T., Bedrick, E. J., Ariyamuthu, V. K., Shetty, A., Qannus, A. A., Mendoza, K., Murugapandian, S., Gupta, G., & Tanriover, B. (2023). Lack of effectiveness of Bebtelovimab monoclonal antibody among high-risk patients with SARS-Cov-2 Omicron during BA.2, BA.2.12.1 and BA.5 subvariants dominated era. PloS one, 18(4), e0279326.
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  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron subvariants are expected to be resistant to Bebtelovimab (BEB) monoclonal antibody (MAb) and the real-world experience regarding its effectiveness is scarce. This retrospective cohort study reports a data analysis in Banner Healthcare System (a large not-for-profit organization) between 4/5/2022 and 8/1/2022 and included 19,778 Coronavirus disease-19 (COVID-19) positive (by PCR or direct antigen testing) patients who were selected from Cerner-Electronic Health Record after the exclusions criteria were met. The study index date for cohort was determined as the date of BEB MAb administration or the date of the first positive COVID-19 testing. The cohort consist of COVID-19 infected patients who received BEB MAb (N = 1,091) compared to propensity score (PS) matched control (N = 1,091). The primary composite outcome was the incidence of 30-day all-cause hospitalization and/or mortality. All statistical analyses were conducted on the paired (matched) dataset. For the primary composite outcome, the event counts and percentages were reported. Ninety-five percent Clopper-Pearson confidence intervals for percentages were computed. The study cohorts were 1:1 propensity matched without replacement across 26 covariates using an optimal matching algorithm that minimizes the sum of absolute pairwise distance across the matched sample after fitting and using logistic regression as the distance function. The pairs were matched exactly on patient vaccination status, BMI group, age group and diabetes status. Compared to the PS matched control group (2.6%; 95% confidence interval [CI]: 1.7%, 3.7%), BEB MAb use (2.2%; 95% CI: 1.4%, 3.3%) did not significantly reduce the incidence of the primary outcome (p = 0.67). In the subgroup analysis, we observed similar no-difference trends regarding the primary outcomes for the propensity rematched BEB MAb treated and untreated groups, stratified by patient vaccination status, age (
• Tanriover, B., Stewart, D., Kamal, L., Saeed, M., Cooper, M., Foutz, J., McGehee, H., & Gupta, G. (2023). The Independent Effects of Kidney Length and Vascular Plaque on Ten-Year Outcomes of Extended Criteria Donor Kidney Transplants. Transplant international : official journal of the European Society for Organ Transplantation, 36, 11373.
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  The independent effects of deceased donor kidney length and vascular plaque on long-term graft survival are not established. Utilizing DonorNet attachments from 4,480 expanded criteria donors (ECD) recovered between 2008 and 2012 in the United States with at least one kidney biopsied and transplanted, we analyzed the relationship between kidney length and vascular plaques and 10-year hazard of all-cause graft failure (ACGF) using causal inference methods in a Cox regression framework. The composite plaque score (range 0-4) and the presence of any plaque (yes, no) was also analyzed. Kidney length was modeled both categorically (12 cm) as well as numerically, using a restricted cubic spline to capture nonlinearity. Effects of a novel composite plaque score 4 vs. 0 (HR 1.08; 95% CI: 0.96, 1.23) and the presence of any vascular plaque (HR 1.08; 95% CI: 0.98, 1.20) were attenuated after adjustment. Likewise, we identified a potential nonlinear relationship between kidney length and the 10-year hazard of ACGF, however the strength of the relationship was attenuated after adjusting for other donor factors. The independent effects of vascular plaque and kidney length on long-term ECD graft survival were found to be minimal and should not play a significant role in utilization.
• Yamauchi, J., Azhar, A., Hall, I. E., Bhalla, A., Potluri, V. S., Tanriover, B., Gupta, G., Imlay, H., Truax, C., Balaraman, V., Raghavan, D., Zimmerman, M., Campsen, J., Rofaiel, G., Baker, T., & Molnar, M. Z. (2023). Comparison of Short-Term Outcomes in Kidney Transplant Recipients from SARS-CoV-2-Infected versus Noninfected Deceased Donors. Clinical journal of the American Society of Nephrology : CJASN, 18(11), 1466-1475.
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  Acceptable post-transplant outcomes were reported in kidney transplant recipients from donors with coronavirus disease 2019 (COVID-19); however, there are no comparative studies with well-matched controls.
• Al-Obaidi, M. M., Gungor, A. B., Kurtin, S. E., Mathias, A. E., Tanriover, B., & Zangeneh, T. T. (2023). The Prevention of COVID-19 in High-Risk Patients Using Tixagevimab-Cilgavimab (Evusheld): Real-World Experience at a Large Academic Center. The American journal of medicine, 136(1), 96-99.
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  Coronavirus disease 2019 (COVID-19) is associated with increased morbidity and mortality among immunocompromised patients. Tixagevimab-cilgavimab (Tix-Cil) is a combination of 2 monoclonal antibodies approved for the prevention of COVID-19 complications in this high-risk group.
• Al-Obaidi, M. M., Gungor, A. B., Nematollahi, S., Zangeneh, T. T., Bedrick, E. J., Johnson, K. M., Low-Adegbija, N. E., Alam, R., Rangan, P., William Heise, C., Ariyamuthu, V. K., Shetty, A., Qannus, A. A., Murugapandian, S., Ayvaci, M. M., Anand, P. M., & Tanriover, B. (2022). Effectiveness of Casirivimab-Imdevimab Monoclonal Antibody Treatment Among High-Risk Patients With Severe Acute Respiratory Syndrome Coronavirus 2 B.1.617.2 (Delta Variant) Infection. Open forum infectious diseases, 9(7), ofac186.
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  Real-world data on the effectiveness of neutralizing casirivimab-imdevimab monoclonal antibody (Cas-Imd mAb) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among high-risk patients may inform the response to future SARS-CoV-2 variants.
• Azhar, A., Kleiboeker, S., Khorsandi, S., Duncan Kilpatrick, M., Khan, A., Gungor, A., Molnar, M. Z., Morales, M., Levy, M., Kamal, L., Moinuddin, I., Kumar, D., Tanriover, B., & Gupta, G. (2023). Detection of Transmissible Severe Acute Respiratory Syndrome Coronavirus-2 From Deceased Kidney Donors: Implications for Kidney Transplant Recipients. Transplantation, 107(2), e65-e67.
• Batra, R. K., Ariyamuthu, V. K., MacConmara, M. P., Gupta, G., Gungor, A. B., & Tanriover, B. (2022). Outcomes of simultaneous liver-kidney transplant using kidneys of deceased donors with acute kidney injury. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.
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  To our knowledge, outcomes from simultaneous liver-kidney transplant (SLKT) when using kidneys from donors with acute kidney injury (AKI) have not been studied. We studied 5344 SLKTs between May 1, 2007, and December 31, 2019, by using Organ Procurement and Transplantation Network registry data supplemented with United Network for Organ Sharing-DonorNet data. Designating a donor as having AKI required by definition that the following criteria were met: (1) the donor's condition aligned with the Kidney Disease: Improving Global Outcomes (KDIGO) international consensus guidelines, and the terminal serum creatinine (Scr) level was greater than or equal to 1.5 times the minimum Scr level for deceased donors before organ recovery, regardless of urine output, and (2) the terminal Scr level was 1.5 mg/dl or higher (a clinically meaningful and intuitive Scr threshold for defining AKI for transplant providers). The primary outcomes were liver transplant all-cause graft failure (ACGF) (defined as graft failures and deaths) and kidney transplant death-censored graft failure (DCGF) at 1 year after transplant. The secondary outcome was the use of mate kidneys. In the study cohort, 4482 donors had no AKI, whereas 862 had AKI (KDIGO AKI stages: stage 1, n = 521; stage 2, n = 202; and stage 3, n = 138). The donors with AKI were young (median age, 35 years), had good organ quality (median kidney donor profile index, 40%), and had a short cold ischemia time (CIT) (median CIT, 10.6 hours). In the group with AKI and the group with no AKI, respectively, liver ACGF at 1 year (11.1% versus 12.9% [p = 0.13]; hazard ratio [HR], 1.20; 95% confidence interval [CI], 0.97-1.49) and kidney DCGF at 1 year (4.6% versus 5.7% [p = 0.18]; HR, 1.27; 95% CI, 0.95-1.70) did not differ in the full multivariable Cox proportional hazard models. The mate kidneys were allocated to deceased donor kidney transplants (n = 3979, 74.5%) and other multiorgan transplants (n = 995, 18.6%). The discard rate in the group with AKI was 10.9% (n = 370), approximately twice as high as that in the group with no AKI (6.2%: p < 0.001). Selected kidneys from deceased donors with AKI can be considered for SLKT.
• Gupta, G., & Tanriover, B. (2023). Donor-derived Cell-free DNA Measurement in Kidney Transplant Patients Without Allograft Dysfunction: More Evidence and More Questions. Transplantation, 107(1), 25-26.
• Gupta, G., Azhar, A., Gungor, A., Molnar, M. Z., Morales, M. K., & Tanriover, B. (2022). Early Data on Utilization and Discard of Organs From COVID-19-infected Donors: A US National Registry Analysis. Transplantation, 106(5), e266-e268.
• Mete, M., Ayvaci, M. U., Ariyamuthu, V. K., Amin, A., Peltz, M., Thibodeau, J. T., Grodin, J. L., Mammen, P. P., Garg, S., Araj, F., Morlend, R., Drazner, M. H., AbdulRahim, N., Kim, Y., Salam, Y., Gungor, A. B., Delibasi, B., Kotla, S. K., MacConmara, M. P., , Mohan Anand, P., et al. (2022). Predicting Post-Heart Transplant Composite Renal Outcome Risk in Adults: A Machine Learning Decision Tool. Kidney international reports, 7(6), 1410-1415.
• Singh, G., DeWalle, J., Tanriover, B., Singh, N., Chang, A. R., & Anand, P. M. (2022). Effect of age and rural residency on perceptions about SARS-CoV-2 pandemic and vaccination in kidney transplant recipients. Transplant infectious disease : an official journal of the Transplantation Society, 24(6), e13943.
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  Transplant patients have poor outcomes in coronavirus-disease 2019 (COVID-19). The pandemic's effects on rural patients' overall care experience, attitudes to telemedicine, and vaccination are poorly understood.
• Singh, G., Gohh, R., Clark, D., Kalra, K., Das, M., Bradauskaite, G., Bleyer, A. J., Tanriover, B., Chang, A. R., & Anand, P. M. (2022). Vignette-Based Reflections to Inform Genetic Testing Policies in Living Kidney Donors. Genes, 13(4).
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  Family history of kidney disease increases risk of end-stage kidney disease (ESKD) in donors. Pre-donation genetic testing is recommended in evaluation guidelines and regulatory policy. Collaborating across several institutions, we describe cases to illustrate the utility as well as practical issues in incorporating genetic testing in transplant protocols. Case 1 is from 2009, before pervasive genetic testing. A healthy 27-year-old Caucasian male had an uneventful donor evaluation for his mother, who had early onset ESKD of unclear cause. He participated in paired-exchange kidney donation, but developed progressive kidney disease and gout over the next 10 years. A uromodulin gene mutation (NM_003361.3():c.377 G>A p.C126Y) was detected and kidney biopsy showed tubulointerstitial kidney disease. The patient subsequently required kidney transplantation himself. Case 2 was a 36-year-old African American female who had an uneventful kidney donor evaluation. She underwent gene panel-based testing to rule out ApolipoproteinL1 risk variants, for which was negative. Incidentally, a sickle-cell trait (NM_000518.5():c.20A>T p.Glu7Val) was noted, and she was declined for kidney donation. This led to significant patient anguish. Case 3 was a 26-year-old Caucasian female who underwent panel-based testing because the potential recipient, her cousin, carried a variant of uncertain significance in the hepatocyte nuclear factor-1-β () gene. While the potential donor did not harbor this variant, she was found to have a likely pathogenic variant in complement factor I (NM_000204.4():c.1311dup:p.Asp438Argfs*8), precluding kidney donation. Our cases emphasize that while genetic testing can be invaluable in donor evaluation, transplant centers should utilize detailed informed consent, develop care pathways for secondary genetic findings, and share experience to develop best practices around genetic testing in donors.
• Stewart, D., Tanriover, B., & Gupta, G. (2022). Oversimplification and Misplaced Blame Will Not Solve the Complex Kidney Underutilization Problem. Kidney360, 3(12), 2143-2147.
• Tanriover, B., Anand, P. M., Ayvaci, M., Murugapandian, S., Qannus, A. A., Shetty, A., ARIYAMUTHU, V. K., Heise, C. W., Rangan, P., Alam, R., Nicole, A., Johnson, K., Bedrick, E. J., Zangeneh, T. T., Nematollahi, S., Gungor, A. b., & Al-Obaidi, M. (2022).

  Effectiveness of Casirivimab-Imdevimab Monoclonal Antibody Treatment Among High-Risk Patients With Severe Acute Respiratory Syndrome Coronavirus 2 B.1.617.2 (Delta Variant) Infection

  . Open forum infectious diseases.
• Özer, Y., Kaplan, S., Sandikçi, B., Gupta, G., & Tanriover, B. (2022). Increased Rates of Kidney Discard in the Era of COVID-19 and Recent KAS Policy Implementation. Transplantation, 106(11), e503-e506.
• MacConmara, M., Wang, B., Patel, M. S., Hwang, C. S., DeGregorio, L., Shah, J., Hanish, S. I., Desai, D., Lynch, R., Tanriover, B., Zeh, H., & Vagefi, P. A. (2021). Liver Transplantation in the Time of a Pandemic: A Widening of the Racial and Socioeconomic Health Care Gap During COVID-19. Annals of surgery, 274(3), 427-433.
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  During the initial wave of the COVID-19 pandemic, organ transplantation was classified a CMS Tier 3b procedure which should not be postponed. The differential impact of the pandemic on access to liver transplantation was assessed.
• Tanriover, B., Lingvay, I., Ahmed, F., Sandikci, B., Mohan, S., Cremers, S., Karmally, W., Mohan, P., Newhouse, J., Ragunathan, S., AbdulRahim, N., Ariyamuthu, V. K., Ratner, L. E., & Cohen, D. J. (2021). Insulin Sensitivity After Living Donor Nephrectomy. Transplantation proceedings, 53(6), 1858-1864.
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  The kidney is essential for glucose and insulin metabolism. Living kidney donors (LKDs) experience a reduction in glomerular filtration rate of 25 to 30 mL/min after donor nephrectomy. Little is known about the effect of glomerular filtration rate decline on insulin sensitivity in LKDs.
• Ariyamuthu, V. K., Sandikci, B., AbdulRahim, N., Hwang, C., MacConmara, M. P., Parasuraman, R., Atis, A., & Tanriover, B. (2020). Trends in utilization of deceased donor kidneys based on hepatitis C virus status and impact of public health service labeling on discard. Transplant infectious disease : an official journal of the Transplantation Society, 22(1), e13204.
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  Kidneys from deceased donors infected with hepatitis C virus (HCV) are underutilized. Most HCV virus-infected donors are designated as Public Health Service increased donors (PHS-IR). Impact of PHS and HCV designations on discard is not well studied.
• Giacoma, T., Ayvaci, M. U., Gaston, R. S., Mejia, A., & Tanriover, B. (2020). Transplant physician and surgeon compensation: A sample framework accounting for nonbillable and value-based work. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 20(3), 641-652.
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  Work relative value unit (wRVU)-based fee schedules are predominantly used by both the Centers for Medicare & Medicaid Services (CMS) and private payers to determine the payments for physicians' clinical productivity. However, under the Affordable Care Act, CMS is transitioning into a value-based payment structure that rewards patient-oriented outcomes and cost savings. Moreover, in the context of solid organ transplantation, physicians and surgeons conduct many activities that are neither billable nor accounted for in the wRVU models. New compensation models for transplant professionals must (1) justify payments for nonbillable work related to transplant activity/procedures; (2) capture the entire academic, clinical, and relationship-building work effort as part of RVU determination; and (3) move toward a value-based compensation scheme that aligns the incentives for physicians, surgeons, transplant center, payers, and patients. In this review, we provide an example of redesigning RVUs to address these challenges in compensating transplant physicians and surgeons. We define a customized RVU (cRVU) for activities that typically do not generate wRVUs and create an outcome value unit (OVU) measure that incorporates outcomes and cost savings into RVUs to include value-based compensation.
• Woll, F., Mohanka, M., Bollineni, S., Joerns, J., Kaza, V., Torres, F., Tanriover, B., & Banga, A. (2020). Characteristics and Outcomes of Lung Transplant Candidates With Preexisting Renal Dysfunction. Transplantation proceedings, 52(1), 302-308.
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  The proportion of lung transplant candidates with comorbid renal dysfunction (RD) may rise as sicker patients are being considered for lung transplant (LT). There is lack of data regarding the characteristics and outcome of patients with RD and the role of simultaneous lung-kidney transplant (SLuKi) among these patients.
• AbdulRahim, N., & Tanriover, B. (2019). Reply. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 25(4), 669-670.
• Amin, A. A., Araj, F. G., Ariyamuthu, V. K., Drazner, M. H., Ayvaci, M. U., Mammen, P. P., Mete, M., Urey, M. A., & Tanriover, B. (2019). Impact of induction immunosuppression on patient survival in heart transplant recipients treated with tacrolimus and mycophenolic acid in the current allocation era. Clinical transplantation, 33(8), e13651.
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  The practice of induction therapy with either rabbit anti-thymocyte globulin (r-ATG) or interleukin-2 receptor antagonists (IL-2RA) is common among heart transplant recipients. However, its benefits in the setting of contemporary maintenance immunosuppression with tacrolimus/mycophenolic acid (TAC/MPA) are unknown.
• Hassler, J., Tanriover, B., Ariyamutu, V., Burguete, D., Hendricks, A. R., & Torrealba, J. R. (2019). 2013 Banff Criteria for Acute Antibody-Mediated Rejection Are Superior to 2007 Banff Criteria in the Diagnosis and Assessment of Renal Allograft Outcomes. Transplantation proceedings, 51(6), 1791-1795.
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  The 2013 Banff meeting updated the requirements for the diagnosis of acute/active antibody-mediated rejection (AAMR) in kidney allografts. There has been speculation that the changes lower the threshold for diagnosing AAMR, and may lead to possible unnecessary and expensive treatment.
• La Hoz, R. M., Sandıkçı, B., Ariyamuthu, V. K., & Tanriover, B. (2019). Short-term outcomes of deceased donor renal transplants of HCV uninfected recipients from HCV seropositive nonviremic donors and viremic donors in the era of direct-acting antivirals. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 19(11), 3058-3070.
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  The United States opioid use epidemic over the past decade has coincided with an increase in hepatitis C virus  (HCV) positive donors. Using propensity score matching, and the Organ Procurement Transplant Network data files from January 2015 to June 2019, we analyzed the short-term outcomes of adult deceased donor kidney transplants of HCV uninfected recipients with two distinct groups of HCV positive donors (HCV seropositive, nonviremic n = 352 and viremic n = 196) compared to those performed using HCV uninfected donors (n = 36 934). Compared to the reference group, the transplants performed using HCV seropositive, nonviremic and viremic donors experienced a lower proportion of delayed graft function (35.2 vs 18.9%; P < .001 [HCV seropositive, nonviremic donors] and 36.2 vs 16.8% ;  P < .001[HCV viremic donors]). The recipients of HCV viremic donors had better allograft function at 6 months posttransplant (eGFR [54.1 vs 68.3 mL/min/1.73 m2; P = .004]. Furthermore, there was no statistical difference in the overall graft failure risk at 12 months posttransplant by propensity score matched multivariable Cox proportional analysis (HR =  0.60, 95% CI  0.23 to  1.29 [HCV seropositive, nonviremic donors] and HR =  0.85, 95% CI 0.25 to  2.96 [HCV viremic donors]). Further studies are required to determine the long-term outcomes of these transplants and address unanswered questions regarding the use of HCV viremic donors.

Reviews

• Kelly, B. G., Stratton, D. B., Mansour, I., Tanriover, B., Culpepper, K. S., & Curiel-Lewandrowski, C. (2022. Navigating the initial diagnosis and management of adult IgA vasculitis: A review(pp 71-78).
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  IgA vasculitis in adults has not been thoroughly studied. This has left a practice gap related to the management and follow-up of a population that is at an increased risk of comorbidities and potentially poor outcomes. For this reason, it is important to synthesize evidence from the current literature because this can help direct the movement for more robust studies to clarify best practice recommendations.
• Shetty, A., Ariyamuthu, V. K., Gungor, A. B., & Tanriover, B. (2023. Utilization of hepatitis C virus-positive donors in kidney transplantation(pp 22-28).
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  Direct-acting antivirals (DAA) have transformed kidney transplantation by increasing the donor pool from hepatitis C virus (HCV)-infected donors and allowing HCV nucleic acid amplification testing (NAT) donor-positive/recipient-negative (D+/R-) transplantation over the last 7 years. Willingness to accept kidneys from HCV-infected donors and timing/duration of DAA therapy have been evolving.