In the current era of direct-acting antiviral therapy, recipients of kidney transplants from deceased donors who test positive for hepatitis C virus (HCV) have 5-year allograft survival rates similar to recipients of kidney transplants from deceased donors who test negative for HCV, according to a recent study.

The findings challenge the validity of the HCV penalty assigned by the Kidney Donor Profile Index (KDPI), a score derived from an allograft survival model that is used to indicate the quality of deceased-donor kidneys for organ allocation. Increasing KDPI scores indicate worsening quality. The KDPI, however, was developed using data from the interferon treatment era, the authors of the current study pointed out. They examined allograft survival outcomes in the direct-acting antiviral therapy era.

Using data from the Organ Procurement and Transplantation Network, a team led by Peter P. Reese, MD, PhD, of the University of Pennsylvania’s Perelman School of Medicine in Philadelphia, conducted a retrospective cohort study of adult deceased-donor kidney recipients from July 1, 2016 to December 31, 2021. The authors noted that starting in 2016, the availability of direct-acting antivirals made it possible to conduct transplantation trials of HCV-infected kidneys into HCV-uninfected recipients.

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Their study cohort consisted of 45,827 deceased donors (43,276 HCV-RNA-negative and 2551 HCV-RNA-positive) and 75,905 kidney recipients (71,498 HCV-RNA-negative and 4407 HCV-RNA-positive) at 217 transplant centers. The 5-year allograft survival rates were 72% for recipients of HCV-RNA-positive donor kidneys and 69% for recipients of HCV-RNA-negative donor kidneys, Dr Reese and colleagues reported in JAMA. The 5-year mean allograft survival times were 4.30 and 4.27 years, respectively. The differences between both outcomes were not statistically significant.

“These findings may provide a rationale for the transplant community to reexamine the KDPI’s HCV penalty,” the authors wrote.


Schaubel DE, Tran AH, Abt PL, Potluri V, Goldberg DS, Reese PP. Five-year allograft survival for recipients of kidney transplants from hepatitis C virus infected vs uninfected deceased donors in the direct-acting antiviral therapy era. JAMA. Published online August 22, 2022. doi:10.1001/jama.2022.12868