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

Abstract

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.

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

“…The American Society of Transplantation Consensus Conference on HCV donors and organ transplantation recently recommended that HCV Ab+/NAT− donors (without other increased risk factors) not be considered at increased risk of HCV transmission . A single‐center study also demonstrated the safety of transplanting HCV Ab+/NAT− donor kidneys into HCV‐negative recipients . Accordingly, our study documents the increased nationwide utilization of HCV Ab+/NAT− donor kidneys in the last 3 years.…”

“…31,32 In our study cohort (the kidneys recovered for transplantation), the PHS-IR kidneys accounted for 23.8% of total organ pool and 21.6% discarded kidneys, and, contrary to common perception, gle-center study also demonstrated the safety of transplanting HCV Ab+/NAT− donor kidneys into HCV-negative recipients. 16 Accordingly, our study documents the increased nationwide utilization of HCV Ab+/NAT− donor kidneys in the last 3 years. This represents a pool of donors that is probably still underutilized, and so far has not resulted in a documented viral transmission and hence may not need antiviral therapy.…”

“…[8][9][10][11] Donors dying due to overdose are more likely to be infected with HCV, 11 and organs from HCV-positive donors are underutilized. [12][13][14][15] Single-center studies have utilized HCV antibody positive 16,17 and viremic donors [18][19][20] for RT with good short-term outcomes. A recent national registry analysis by our group confirms excellent short-term outcomes for such transplants.…”

Center-level trends in utilization of HCV-exposed donors for HCV-uninfected kidney and liver transplant recipients in the United States

“…[15][16][17]21,22 We were somewhat surprised to find that the use of HCVaviremic (Ab+/NAT−) donors for HCV-unexposed recipients was so highly clustered, as this practice has a lower risk of HCV transmission and is less controversial. As transplant centers consider using HCV Ab+ donors for Ab− recipients, the differential probability of HCV transmission posed by aviremic kidney donors (very unlikely), aviremic liver donors (potential), and viremic kidney and liver donors (very likely) can be used to inform treatment and consent protocols as necessary.…”

“…2,3 However, despite DAA availability and increased use among HCV Ab+ recipients, high-quality HCV Ab+ donor organs remain underutilized. 16,17 Given the low risk of transmission and survival benefit of transplantation, some advocate using HCV Ab+ aviremic donors more broadly. 1,[6][7][8][9][10][11][12][13][14] The risk of HCV transmission, which depends on the presence or absence of viremia, is an important consideration when using HCV Ab+ donors for HCV-recipients.…”