Effect of kidney donor hepatitis C virus serostatus on renal transplant recipient and allograft outcomes

Abstract

BackgroundHepatitis C virus (HCV) infection is common in dialysis patients and renal transplant recipients and has been associated with diminished patient and allograft survival. HCV-positive (HCV+) kidneys have been used in HCV-positive (HCV+) recipients as a means of facilitating transplantation and expanding the organ donor pool; however, the effect of donor HCV serostatus in the modern era is unknown.MethodsUsing national transplant registry data, we created a propensity score–matched cohort of HCV+ recipients who received HCV-positive donor kidneys compared to those transplanted with HCV-negative kidneys.ResultsTransplantation with an HCV+ kidney was associated with an increased risk of death {hazard ratio [HR] 1.43 [95% confidence interval (CI) 1.18–1.76]; P < 0.001} and allograft loss [HR 1.39 (95% CI 1.16–1.67); P < 0.001] compared with their propensity score–matched counterparts. However, HCV+ kidneys were not associated with an increased risk of acute rejection [odds ratio 1.16 (95% CI 0.84–1.61); P = 0.35].ConclusionsWhile use of HCV+ donor kidneys can shorten the wait for renal transplantation and maximize organ utility for all candidates on the waiting list, potential recipients should be counseled about the increased risks associated with HCV+ kidney.

The Drug Overdose Epidemic and Deceased-Donor Transplantation in the United States

“…Discard of HCV-positive kidneys and livers might be warranted in certain circumstances; some studies of HCV-positive recipients have shown worse posttransplant outcomes with HCV-positive versus HCV-negative kidneys and livers (13, 14). However, studies have shown that patients who accept HCV-positive organs have reduced wait times (14) and outcomes similar to those with HCV-negative organs (34).…”

“…The IRD label might reduce use of ODD organs because it is associated with organ discard (surgical recovery without subsequent use for transplant) (12). Moreover, ODDs are increasingly positive for HCV antibodies (10, 11), and inferior outcomes might be expected due to HCV infection (13–16). Finally, concerns that illicit drug use compromises organ quality might exist; for example, injection drug use is associated with lung granulomatosis (17).…”

Hepatitis C virus (HCV) RNA level in plasma and kidney tissue in HCV antibody‐positive donors: Quantitative comparison

“…Chronic kidney disease is a common extrahepatic manifestation associated with HCV‐induced cryoglobulinemia vasculitis . While kidney transplant outcomes from HCV‐positive donors have been reported to be inferior to transplants performed using HCV‐negative donors, acceptance of HCV antibody‐positive donors significantly shortens transplant candidate waiting times . Similar or favorable transplant outcomes are reported among HCV‐positive recipients who accepted HCV‐positive donor grafts compared to those who remained on the wait list longer and received HCV‐negative grafts …”

Successful heart‐kidney transplantation from a Hepatitis C viremic donor to negative recipient: One year of follow‐up

“…As mentioned, HCV infection in heart transplant recipients has been associated with liver failure, renal dysfunction, CAV, and increased mortality after transplant compared to non‐HCV organs . Additionally, in renal transplant, recipients with active HCV have an increased risk of death and allograft loss . Thus, this potential donor pool has been largely underutilized.…”