Most kidneys from donors infected with hepatitis C virus (HCV) are being transplanted into recipients without the infection, and these kidneys show good short-term function, according to new data published in the Journal of the American Society of Nephrology.
Before 2015, many kidneys from deceased donors with HCV were discarded. Seminal trials then showed that these kidneys could be successfully transplanted into patients with and without HCV infection.
During January to March 2019, 200 HCV-seropositive donor kidneys were transplanted into HCV-seronegative recipients compared with 69 into HCV-seropositive recipients, according to national data from the Organ Procurement and Transplantation Network, Vishnu Potluri, MD, MPH, of the University of Pennsylvania in Philadelphia, and colleagues reported. Another 105 HCV-viremic kidneys (39%) were discarded. The number of kidney transplant candidates willing to accept an HCV-seropositive kidney jumped from 2936 in December 2015 to 16,809 in March 2019. The number of transplant centers using HCV-infected donor kidneys in uninfected recipients likewise increased from 11 in 2015 to 33 in 2018 to 39 in early 2019.
“By the end of 2019, 74% of HCV-viremic kidneys were transplanted into seronegative recipients – a major change from how HCV-viremic kidneys were allocated a few years ago,” the authors noted.
The new data show that HCV-infected allografts transplanted into HCV-seronegative recipients function well in the short term. At 1 year, the investigators found that the estimated glomerular filtration rate (eGFR) of allografts with and without HCV infection were similar (66.3 and 67.1 mL/min/1.73m2, respectively). HCV-infected kidneys were matched to kidneys without HCV infection on predictors of organ quality, except HCV.
Among recipients of HCV-infected allografts, no clinically meaningful difference in eGFR at 1 year was observed by serostatus: 66.5 vs 71.1 mL/min/1.73m2 for HCV-seronegative versus HCV-seropositive recipients.
The kidney donor profile index (KDPI) currently assigns a substantially worse score to kidneys from HCV-seropositive donors. “These striking results provide important additional evidence that the KDPI, with its current negative weightage for HCV status, does not accurately assess the quality of kidneys from HCV-viremic donors,” Dr Potluri and the team stated.
In the current era, treating HCV infection with direct-acting antivirals improves posttransplant outcomes, research shows. “As use of HCV-viremic kidneys becomes mainstream, the use of these organs in individuals with previously treated HCV infection is a new clinical scenario that transplant centers and referring nephrologists may have to confront,” the study authors pointed out.
Although the discard rate of HCV-infected kidneys has been declining, “the 39% discard rate for HCV-viremic kidneys donated between January and March 2019 suggests that a substantial opportunity remains to increase access to kidney transplantation in the future by maximizing the use of these organs,” Dr Potluri and colleagues stated.
Potluri VS, Goldberg DS, Mohan S, et al. National trends in utilization and one-year outcomes with transplantation of HCV-viremic kidneys [published online September 12, 2019]. J Am Soc Nephrol. doi:10.1681/ASN.2019050462