Donor hepatitis C antibody positivity misclassifies kidney donor profile index in non‐hepatitis C‐infected donors: time to revise the kidney donor profile index – a retrospective cohort study

Abstract

Summary The kidney donor profile index (KDPI) defines an hepatitis C (HCV) positive donor based on HCV antibody (Ab) and/or nucleic acid amplification test (NAT) positivity, with donors who are not actively infected (Ab+/NAT−) also classified as HCV positive. From Scientific Registry of Transplant Recipients dataset, we identified HCV‐negative recipients, who received a kidney transplant from HCV Ab+/NAT− (n = 116) and HCV Ab−/NAT− (n = 25 574) donor kidneys. We then compared recipients’ estimated glomerular filtration rate (eGFR) at 6 months in matched cohorts, using combined exact matching (based on KDPI) and propensity score matching. We created two separate matched cohorts: for the first cohort, we used the allocation KDPI, while for the second cohort we used an optimal KDPI, where the HCV component of KDPI was considered negative in Ab+/NAT− patients. The mean ± SD age of the allocation KDPI‐matched cohort at baseline was 59 ± 10 years, 69% were male, 61% were white. Recipients’ eGFR at 6 months after transplantation was significantly higher in the HCV Ab+/NAT− group compared to the HCV Ab−/NAT− group (61.1 ± 17.9 vs. 55.6 ± 18.8 ml/min/1.73 m2, P = 0.011) in the allocation KDPI‐matched cohort, while it was similar (61.8 ± 19.5 vs. 62.1 ± 20.1 ml/min/1.73 m2, P = 0.9) in the optimal KDPI‐matched cohort. Recipients who received HCV Ab positive, but NAT‐negative donor kidneys did not experience worse 6‐month eGFR than correctly matched HCV Ab−/NAT− recipients.

Curative Therapies for Hepatitis C Virus Infection in Patients with Kidney Disease

“…Additionally, 1-year allograft outcomes for HCV-viremic kidneys were not meaningfully different if transplanted into recipients who were HCV seronegative versus HCV seropositive. These results provide important evidence that the current KDPI penalty for HCV status may not accurately assess the quality of kidneys from donors with HCV in the era of curative DAAs (76,79).…”

A review of kidney transplantation from HCV-viremic donors into HCV-negative recipients

“…30,64,65 Moreover, kidney allograft function at 6 and 12 months in recipients of both HCV-seropositive but aviremic and HCVviremic organs is superior to that in patients who received kidneys from HCV-negative donors with matching KDPI. 54,66,67 This result is not surprising, as HCV-infected donors are frequently younger, brain-dead donors with fewer chronic comorbid conditions, compared to HCVnegative donors with similar KDPI. 24,25,29 The higher KDPI score assigned to HCV-positive kidneys increases the risk for organ discard, and in the US kidney allocation system, higher scores will commonly exclude these organs from preferential allocation to younger recipients who are prioritized to receive low-KDPI organs.…”

Outcomes of kidney, liver, and simultaneous liver and kidney transplants from hepatitis c infected donors to hepatitis c naïve recipients: A large single center experience

“…We also endorse that KDPI calculations should exclude HCV Ab+/NAT− kidneys and should be calculated as though they were HCV-, due to Ab+/NAT− kidney transplants having similar outcomes to Ab−/NAT− kidney transplants. 19 For example, HCV+ non-viremic kidneys have comparable 1-year graft survival rates to HCV-kidneys and no transmission rates compared to HCV+ viremic kidneys following transplant.…”