Discarding of kidneys from donors infected with hepatitis C virus (HCV) has decreased markedly from 2014 to 2019.
“There is now equivalent use of kidneys from aviremic seropositive donors and kidneys from aviremic seronegative donors,” investigators led by Tarek Alhamad, MD, of Washington University School of Medicine in St. Louis, Missouri, concluded in the Clinical Journal of the American Society of Nephrology.
Still, kidneys from viremic donors had 48% increased odds of discard in 2019, they noted. “There are opportunities for more transplant centers to utilize these organs to expand access to transplant,” Dr Alhamad and colleagues wrote. “Broader utilization would benefit from financial coverage for post-transplant DAAs [direct-acting antivirals], which would result in wider adoption of protocols to transplant kidneys from viremic donors to uninfected recipients.”
Since 2014, use of DAAs for HCV treatment has resulted in a cure rate of greater than 90%, “which has revolutionized the practice for managing HCV infection,” the investigators pointed out.
Using data from the Organ Procurement and Transplantation Network (OPTN), Dr Alhamad and colleagues identified 225,479 deceased-donor kidneys recovered from 2005 to 2019 and performed 2 analyses. The first analysis looked only at donor HCV antibody status (HCV seropositive vs HCV seronegative). The second included 82,090 kidneys recovered after March, 31, 2015, when nucleic acid amplification testing (NAT) results were available to determine the presence or absence of viremia. This analysis considered both donor HCV antibody and viremia status. Investigators categorized patients as NAT positive, regardless of HCV antibody status, aviremic seropositive, and aviremic seronegative.
The first analysis demonstrated that, compared with HCV-seronegative kidneys, the odds of HCV-seropositive kidney discard decreased from 7.34-fold in 2013 (prior to the DAA era) to 1.20-fold in 2019, on multivariable analysis. In the second analysis, compared with HCV-aviremic seronegative kidneys, the odds of HCV-viremic kidney discard decreased from 7.09-fold in 2017 to 1.48-fold in 2019, Dr Alhamad and colleagues reported.
By 2018 and 2019, aviremic seropositive status was not associated with higher odds of discard.
With regard to study limitations, the authors noted that their investigation was retrospective so their analyses rely on the accuracy of recorded data. In addition, NAT results were only available in the OPTN data since March 31, 2015. “Therefore, we were unable to describe an earlier trend for viremic or aviremic seropositive kidney discards before and at the beginning of the DAA era,” they wrote. “Nonetheless, our NAT results contained data from March 31, 2015 to September 30, 2019, allowing us to study the time trend of approximately 5 years in the post-DAA era.”
Chang SH, Merzkani M, Lentine KL, et al. Trends in discard of kidneys from hepatitis C viremic donors in the United States. Clin J Am Soc Nephrol. 2021;1:251-261. doi:10.2215/CJN.10960720.