Shorter Waitlist Times and Improved Graft Survivals Are Observed in Patients Who Accept Hepatitis C Virus+ Renal Allografts

Scalea, Joseph R.; Barth, Rolf N.; Munivenkatappa, Raghava; Philosophe, Benjamin; Cooper, Matthew; Whitlow, Victoria; LaMattina, John C.

doi:10.1097/tp.0000000000000479

Cited by 54 publications

(62 citation statements)

References 14 publications

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“…Although there was no significant difference in willingness to accept an HCV-positive organ amongst those who knew HCV was curable or not, offering a decreased waitlist time by 6 months increased the willingness of patients to accept an HCV-positive organ by 15%. Our data suggests that decreasing waitlist times by offering HCV-positive organs, as proven in a previous study, will likely entice some patients to accept HCV-positive organs when they originally would not have [19]. Importantly, patients who were more willing to accept an HCV-positive organ had significantly more trust in their doctor, suggesting that building a robust doctor-patient relationship can positively affect a patient's decision on whether to accept an HCV-positive organ.…”

Section: Discussionmentioning

confidence: 61%

“…Researchers are studying different methods of both prevention, with DAA prophylaxis given pre-transplant and continued in the post-transplant setting, and cure, with DAA therapy administered post-transplant based upon a positive HCV viral load [16][17][18]. This practice would likely increase the number of organs available for transplantation, given the shorter waitlist times seen on the kidney transplant list for patients receiving HCV-positive kidneys and the significant number of HCV-positive organs that are discarded yearly [5,6,19].…”

Section: Introductionmentioning

confidence: 99%

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Use of Hepatitis C Positive Organs: Patient Attitudes in Urban Chicago

et al. 2018

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Background: Hepatitis C virus (HCV)-infected organs are being transplanted in patients with and without HCV in the direct-acting antiviral era. Little is known about patient attitudes towards receiving an HCV-positive organ. Objectives: The aim of this study is to determine transplant candidates’ attitudes towards receiving HCV-positive organs. Methods: Adult solid organ transplant candidates were identified during a clinic visit or during outpatient hemodialysis from May to December 2017. Willing participants completed a survey. Descriptive analysis including mean and median for continuous variables and frequencies for categorical variables were calculated by the appropriate statistical method and compared across willing, unsure, and unwilling patients and between willing and unsure/unwilling patients. Results: Fifty patients were surveyed with median age 54.5 years (range 32–77). Eighty-eight percent were awaiting kidney transplant, and 12% were awaiting other organs. Median waitlist time was 39.8 months (range 1.7–203 months). Most patients (90%) had prior knowledge of HCV, but only 60% knew it was curable. Forty-six percent were willing, 30% were unsure, and 24% were unwilling to receive an HCV-positive organ. Those willing to accept an HCV-positive organ were significantly older, Caucasian, had shorter waitlist times, and had greater physician trust than those that were unsure/unwilling. Similar worries, such as HCV incurability, insurance coverage, fears over the organ not working, and post-transplant death, were expressed in both the willing and unsure/unwilling patients. Conclusions: The availability of HCV-positive organs may expand the donor pool and decrease waitlist times and mortality. These data highlight the need for patient education towards use of these organs.

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Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Use of Hepatitis C Positive Organs: Patient Attitudes in Urban Chicago

et al. 2018

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“…Analysing more than 1600 kidney transplantations, Scalea et al found that R+/D+ patients spent less time on the transplant waitlist, which contributed to improved death censored graft survival when compared with R+/D-patients (103). Others found that patients receiving ECD transplants had lower allograft survival after seven years than patients receiving transplants from standard criteria donors (SCD; 80% v 88%, P<0.001).…”

Section: V) Expert Commentarymentioning

confidence: 99%

Extended criteria donors in liver transplantation Part I: reviewing the impact of determining factors

Nemes

Gámán

Polak

et al. 2016

Expert Review of Gastroenterology & Hepatology

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“…Therefore, it is quite possible that the overall quality of kidneys from HCV-infected donors is being underestimated now that we can readily cure HCV infection after kidney transplant with direct-acting antiviral therapies that do not compromise graft function [10-13]. A recent analysis by Scalea et al [14] even suggests that HCV-infected KT recipients accepting HCV-infected kidneys may have higher rates of graft survival than those accepting uninfected donor kidneys, possibly mediated by their decreased time on dialysis prior to transplant.…”

Section: Discussionmentioning

confidence: 99%

Effect of the Opioid Crisis on the Donor Pool for Kidney Transplantation: An Analysis of National Kidney Deceased Donor Trends from 2010–2016

Chute

Sise

2018

Am J Nephrol

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Background: The opioid crisis has led to a dramatic increase in the number of drug overdose deaths in the United States. Little is known about the effect of the opioid crisis on the kidney transplant donor pool, particularly on hepatitis C virus (HCV)-infected donors. Methods: This is a retrospective analysis of the data from the Organ Procurement and Transplantation Network from 2010 to 2016. We determined the changes in characteristics of kidney transplant donors and evaluated which changes may be directly related to the opioid crisis. Results: Between 2010 and 2016, we found a 26% increase in overall donors, including a 277% increase in the number of donors who died from drug overdose. Nineteen percent of donors who died of drug overdose had HCV infection. Donors who die from drug overdose and donors with HCV infection are younger, less likely to have diabetes or hypertension, and have favorable kidney donor profile index scores compared to average donors. Despite these favorable characteristics, HCV-infected donors appear to be notably underutilized, with substantially lower kidneys per donor being transplanted compared to HCV uninfected donors. Conclusion: The opioid crisis in the United States has substantially altered the kidney donor pool. Strategies to increase utilization of all potentially viable kidneys for transplant are needed, particularly in this era of new, highly effective, direct-acting antiviral therapy for HCV infection.

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Shorter Waitlist Times and Improved Graft Survivals Are Observed in Patients Who Accept Hepatitis C Virus+ Renal Allografts

Abstract: R+/D+ patients spent less time on the transplant waitlist, which contributed to improved death censored graft survival when compared with R+/D- patients.

Cited by 54 publications

References 14 publications

Use of Hepatitis C Positive Organs: Patient Attitudes in Urban Chicago

Use of Hepatitis C Positive Organs: Patient Attitudes in Urban Chicago

Extended criteria donors in liver transplantation Part I: reviewing the impact of determining factors

Effect of the Opioid Crisis on the Donor Pool for Kidney Transplantation: An Analysis of National Kidney Deceased Donor Trends from 2010–2016

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