National Trends in Utilization and 1-Year Outcomes with Transplantation of HCV-Viremic Kidneys

Recent pilot trials have demonstrated the safety of transplanting HCV-viremic kidneys into HCV-seronegative recipients. However, it remains unclear if allograft function is impacted by donor HCV-viremia or recipient HCV-serostatus. We used national United States registry data to examine trends in HC...

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Bibliographic Details
Published in:Journal of the American Society of Nephrology Vol. 30; no. 10; p. 1939
Main Authors: Potluri, Vishnu S, Goldberg, David S, Mohan, Sumit, Bloom, Roy D, Sawinski, Deirdre, Abt, Peter L, Blumberg, Emily A, Parikh, Chirag R, Sharpe, James, Reddy, K Rajender, Molnar, Miklos Z, Sise, Meghan, Reese, Peter P
Format: Journal Article
Language:English
Published: United States 01.10.2019
Subjects:
Adult
Aged
Female
Hepatitis C
Humans
Kidney Transplantation - statistics & numerical data
Male
Middle Aged
Procedures and Techniques Utilization - statistics & numerical data
Procedures and Techniques Utilization - trends
Retrospective Studies
Time Factors
Tissue and Organ Procurement - methods
Tissue and Organ Procurement - standards
Tissue Donors
Treatment Outcome
United States
Viremia
United States
end stage kidney disease
hepatitis
kidney transplantation
transplantation
ISSN:1533-3450, 1533-3450
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Summary:Recent pilot trials have demonstrated the safety of transplanting HCV-viremic kidneys into HCV-seronegative recipients. However, it remains unclear if allograft function is impacted by donor HCV-viremia or recipient HCV-serostatus. We used national United States registry data to examine trends in HCV-viremic kidney use between 4/1/2015 and 3/31/2019. We applied advanced matching methods to compare eGFR for similar kidneys transplanted into highly similar recipients of kidney transplants. Over time, HCV-seronegative recipients received a rising proportion of HCV-viremic kidneys. During the first quarter of 2019, 200 HCV-viremic kidneys were transplanted into HCV-seronegative recipients, versus 69 into HCV-seropositive recipients, while 105 HCV-viremic kidneys were discarded. The probability of HCV-viremic kidney discard has declined over time. Kidney transplant candidates willing to accept a HCV-seropositive kidney increased from 2936 to 16,809 from during this time period. When transplanted into HCV-seronegative recipients, HCV-viremic kidneys matched to HCV-non-viremic kidneys on predictors of organ quality, except HCV, had similar 1-year eGFR (66.3 versus 67.1 ml/min per 1.73 m , =0.86). This was despite the much worse kidney donor profile index scores assigned to the HCV-viremic kidneys. Recipient HCV-serostatus was not associated with a clinically meaningful difference in 1-year eGFR (66.5 versus 71.1 ml/min per 1.73 m , =0.056) after transplantation of HCV-viremic kidneys. By 2019, HCV-seronegative patients received the majority of kidneys transplanted from HCV-viremic donors. Widely used organ quality scores underestimated the quality of HCV-viremic kidneys based on 1-year allograft function. Recipient HCV-serostatus was also not associated with worse short-term allograft function using HCV-viremic kidneys.
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ISSN:1533-3450
1533-3450
DOI:10.1681/ASN.2019050462