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

Abstract

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. K E Y W O R D S clinical research/practice, infection and infectious agents -viral: hepatitis C, infectious disease, kidney (allograft) function/dysfunction, kidney transplantation/nephrology 1 | INTRODUC TI ON Kidney transplantation is the treatment of choice for end-stage renal disease (ESRD). It extends life, improves quality of life, and reduces cost compared to maintenance dialysis. 1,2 Although mortality in patients on the renal transplant waitlist has decreased, it remains unacceptably high (up to 12.7 per 100 patients-year) in certain regions of the United States (US). 3 Data in 2016 from the Scientific Registry of Transplant Recipients (SRTR) revealed that more than 25% of the 33 291 adult patients removed from the kidney transplant waitlist were withdrawn due to death or deteriorating medical condition. This withdrawal rate reflects the excessive wait times | 3059 LA HOZ et AL.

Liver, simultaneous liver‐kidney, and kidney transplantation from hepatitis C‐positive donors in hepatitis C‐negative recipients: A single‐center study

“…There was no significant difference in overall graft survival or patient mortality. Further, the KDPI score was numerically lower than would historically be expected of HCV‐positive donors, which is impressive especially as HCV status is a component in the KDPI score . Similarly, the median KDPI score among patients in our series of HCV NAT (+) recipients was 52%, which was not significantly different from the median KDPI among recipients of HCV NAT (−) organs at our institution during the same time period (45%).…”

“…Even among these patients, the persistence of HCV infection post‐transplantation was associated with poor outcomes and led to worse post‐transplant survival . However, the advent of highly effective direct‐acting antiviral therapy (DAAs) has led to post‐transplantation HCV cure rates exceeding 95%, and with it, a negation of the ill effects of HCV previously seen in both LT and KT recipients . A number of clinical trials, along with data from the HCV‐TARGET cohort, have demonstrated the efficacy and safety of the use of these agents in the post‐transplant setting .…”

“…While registry data suggest excellent outcomes for HCV‐negative patients transplanted with HCV Ab (+) or ‐NAT(+) organs, there are fewer center‐level data available on this experience in LT and KT. The largest published series in LT comprised 10 patients, while in KT, the available data are predominantly from large registry data or industry‐sponsored trials, which may not always reflect the conditions of clinical practice, including the need to wait for insurance authorization before starting treatment . Therefore, this study aims to describe our experience in HCV‐positive to ‐negative organ transplantation with HCV NAT (+) donors.…”

Trends in utilization of deceased donor kidneys based on hepatitis C virus status and impact of public health service labeling on discard

“…Single‐center studies have utilized HCV antibody positive and viremic donors for RT with good short‐term outcomes. A recent national registry analysis by our group confirms excellent short‐term outcomes for such transplants …”

“…One UNOS study of Ab+/NAT− kidneys concludes that if such kidneys are considered to be HCV‐, their survival would be comparable to the matched non‐HCV‐infected kidneys, less likely to be classified as KDPI > 85%, and the risk of DGF was significantly lower when compared to non‐HCV kidneys . A recent companion study also confirms similar or superior short‐term outcomes from transplantation with HCV+ kidneys . Hence, some authors even question the need for including HCV Ab result with donor offers and KDPI calculations and recommend uniform utilization of NAT status alone …”