Kidney transplantation from a donor who is HCV antibody positive and HCV-RNA negative

Tokumoto, Tadahiko; Tanabe, Kazunari; Simizu, T.; Shimmura, Hiroaki; Iizuka, Junpei; Ishikawa, Nobuo; Oshima, Tadashi; Yagisawa, T; Goya, Nobuyuki; Nakazawa, Hayakazu; Toma, Hiroshi

doi:10.1016/s0041-1345(00)01572-4

Cited by 17 publications

(11 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…At our center, the use of HCV Ab+/NAT− donor kidneys is discussed with kidney transplant candidates during the initial evaluation, at subsequent pretransplant visits, and again at the time of the offer. Patients are told that there is a possibility of false‐positive serologic testing but more than likely, these donors had had HCV infection and either cleared the infection spontaneously or with treatment, and that there has been no reported transmission of HCV infection from these nonviremic donors after kidney transplantation . Informed consent is obtained prior to the transplant with full disclosure of donor information to the recipient, especially the social history and drug use.…”

Section: Discussionmentioning

confidence: 99%

“…The importance of distinguishing between HCV NAT+ (viremic) versus HCV antibody (Ab)+/NAT− (nonviremic) donors has been recognized, and there has been a call to redefine the definition of an “HCV positive donor.” Whereas HCV NAT positivity (regardless of HCV Ab status) is diagnostic of active HCV infection, HCV Ab+/NAT− status is indicative of either cleared HCV infection (either spontaneously or with treatment) or false‐positive (antibody) testing. There has been no reported transmission of HCV infection in recipients of HCV Ab+/NAT− donor kidneys, and anecdotal reports have suggested that transplantation of HCV Ab+/NAT− donor kidneys into HCV negative recipients, such as a living donor who cleared HCV infection after treatment, does not result in HCV transmission . A report of 21 patients in the mid 2000s who received kidney transplants from HCV Ab+/HCV polymerase chain reaction (PCR)‐ donors also showed no transmission of HCV infection to recipients; however, not all patients in that study were tested posttransplant for HCV RNA .…”

Section: Introductionmentioning

confidence: 94%

See 1 more Smart Citation

Transplantation of hepatitis C virus (HCV) antibody positive, nucleic acid test negative donor kidneys to HCV negative patients frequently results in seroconversion but not HCV viremia

Vera

Volk

Ncube

et al. 2018

American Journal of Transplantation

View full text Add to dashboard Cite

Anecdotal reports have suggested that transplantation of hepatitis C virus (HCV) antibody positive (Ab+)/nucleic acid test negative (NAT-) donor kidneys into HCV negative recipients is not associated with HCV transmission. We reviewed our center's outcomes of 32 HCV negative patients who received kidney allografts from 25 donors who were HCV Ab+/NAT-. The mean recipient age was 56.9 ± 12.1 years and the mean donor age was 41.5 ± 14 years, with a median Kidney Donor Profile Index (KDPI) of 68%. Twelve donors (48%) met Public Health Service (PHS) increased risk status. All patients received antithymocyte globulin induction followed by tacrolimus, mycophenolate mofetil, and steroid maintenance immunosuppression. With a mean follow-up posttransplant of 10 ± 2.7 months, 1- and 3- month serum creatinine levels were 1.7 ± 0.8 and 1.3 ± 0.4, respectively, and patient and graft survival rates were 100% and 97%, respectively. Fourteen patients (44%) seroconverted and became HCV Ab+ posttransplant. However, all 32 patients were HCV RNA negative at 1- and 3- months posttransplant, and 27 and 8 patients tested at 6- and 12-months posttransplant, respectively, remain HCV RNA negative. In conclusion, transplantation of HCV Ab+/NAT- kidneys to HCV negative recipients frequently causes HCV Ab seroconversion but not HCV viremia.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

Transplantation of hepatitis C virus (HCV) antibody positive, nucleic acid test negative donor kidneys to HCV negative patients frequently results in seroconversion but not HCV viremia

Vera

Volk

Ncube

et al. 2018

American Journal of Transplantation

View full text Add to dashboard Cite

show abstract

“…These organs should increasingly be considered for transplant, as the infectious risk to the recipient is likely zero . No transmissions have been reported from such donors and living donors with cleared or treated HCV have successfully donated without transmission to recipients …”

Section: Discussionmentioning

confidence: 99%

“…14 recipients. [15][16][17][18][19][20] Hepatitis B virus, with its different biology and replication, has a different mechanism of action and lack of viremia does not necessar- transplant. In this study, we found that the detection of seropositive,…”

Section: Discussionmentioning

confidence: 99%

Deceased organ donor screening for human immunodeficiency virus, hepatitis B virus and hepatitis C virus: Discordant serology and nucleic acid testing results

Theodoropoulos

Nowicki

Chinchilla-Reyes

et al. 2018

Transplant Infectious Dis

View full text Add to dashboard Cite

show abstract

“…As a result, all deceased donors with a detectable HCV Ab were labeled as “HCV positive.” However, HCV Ab‐positivity may reflect active infection, spontaneously cleared infection, or treated infection . There are no published data demonstrating that donors with cleared or treated HCV pose any risk for HCV transmission . Further, HCV has not been considered a disease that reactivates in the setting of immunosuppression.…”

mentioning

confidence: 99%

Maximizing Utilization of the Donor Pool by Appropriate Classification of Hepatitis C Antibody-Positive Donors

Anesi

Goldberg

2017

American Journal of Transplantation

View full text Add to dashboard Cite

The most significant issue facing solid organ transplantation (SOT) is the limited supply of donor organs. Expansion of the donor pool is needed to save more lives through SOT. Deceased donors with positive hepatitis C (HCV) serologic testing have been used inconsistently in the past due to concern for worse recipient outcomes and an inability to easily treat HCV in nonliver recipients (1). Prior to 2015, the United Network for Organ Sharing (UNOS) required only HCV antibody (Ab) testing on deceased donors. As a result, all deceased donors with a detectable HCV Ab were labeled as "HCV positive." However, HCV Ab-positivity may reflect active infection, spontaneously cleared infection, or treated infection (2). There are no published data demonstrating that donors with cleared or treated HCV pose any risk for HCV transmission (1,3,4). Further, HCV has not been considered a disease that reactivates in the setting of immunosuppression. HCV nucleic acid testing (NAT) is able to distinguish active infection from cleared or treated infection, and since 2015, HCV NAT testing has also been required for all deceased donors. Since that time, it has been argued that organs from HCV Ab-positive NAT-negative donors should be considered no different than HCV Ab-negative donors and be more broadly utilized for all patients (1).Armed with these data, Kling et al evaluated national data on deceased donors to evaluate utilization of organs by donor HCV Ab and NAT status, and the impact that increased use of HCV Ab-positive NAT-negative organs would have on the donor pool (5). Over a 1-year period between 2015 and 2016, the authors found that although the vast majority of UNOS deceased donors were both Ab-and NAT-negative, 1.8% were HCV Ab-positive NATnegative, and 4.2% were Ab-positive NAT-positive. Further, they found that the clinical characteristics of HCV Ab-positive NAT-negative donors were otherwise favorable for donation: they were young, suffered brain death, and had few medical comorbidities.To evaluate the magnitude of the unused organs from HCV Ab-positive NAT-negative donors, the authors developed a predictive model to determine the number of additional organs that would be available from these donors after adjusting for other factors that might impact organ utilization. They found that use of HCV Ab-positive NAT-negative donors could add 48 kidney donors, 37 heart donors, 15 lung donors, 9 pancreas donors, and 1 small bowel donor in a 1-year period. It would not expand the liver donor pool since HCV Ab-positive donors are already used for liver transplantation at a high rate. They also found that using Ab-positive NAT-positive donors would increase the donor pool notably; there is early documentation of success with this approach, though this is a more complex decision given the need to treat the recipient for HCV posttransplant (6).There are a few limitations of the described study. First, the use of UNOS data underestimates the true impact of adding HCV Ab-positive NAT-negative donors, since UNOS only counts deceased...

show abstract

Kidney transplantation from a donor who is HCV antibody positive and HCV-RNA negative

Cited by 17 publications

References 4 publications

Transplantation of hepatitis C virus (HCV) antibody positive, nucleic acid test negative donor kidneys to HCV negative patients frequently results in seroconversion but not HCV viremia

Transplantation of hepatitis C virus (HCV) antibody positive, nucleic acid test negative donor kidneys to HCV negative patients frequently results in seroconversion but not HCV viremia

Deceased organ donor screening for human immunodeficiency virus, hepatitis B virus and hepatitis C virus: Discordant serology and nucleic acid testing results

Maximizing Utilization of the Donor Pool by Appropriate Classification of Hepatitis C Antibody-Positive Donors

Contact Info

Product

Resources

About