Should we be using kidneys from hepatitis C virus-infected donors?

Area of Science:

• Nephrology
• Transplantation Immunology
• Infectious Diseases

Background:

• Kidney transplantation is a vital treatment for end-stage renal disease.
• The use of organs from donors positive for hepatitis C virus (HCV) remains a complex ethical and clinical consideration.
• Decreasing HCV prevalence in dialysis patients leads to underutilization of HCVD-positive donor kidneys.

Purpose of the Study:

• To evaluate the safety and efficacy of transplanting kidneys from HCVD-positive donors into HCV-positive recipients.
• To compare outcomes of recipients of HCVD-positive kidneys with those on the waitlist.
• To explore strategies for improving the utilization of HCVD-positive donor organs.

Main Methods:

• Analysis of registry data comparing outcomes based on donor HCV status.
• Review of collaborative studies on HCV RNA-positive recipients of HCVD-positive kidneys.
• Examination of factors influencing graft and patient survival, including HCV genotype matching.

Main Results:

• Transplantation with HCVD-positive kidneys shortens wait times but may slightly increase risks of death and graft loss compared to HCVD-negative donors.
• Recipients of HCVD-positive kidneys demonstrate improved survival rates compared to patients remaining on the waitlist.
• HCV serology is not an independent long-term risk factor for liver disease, graft survival, or patient survival in this cohort.
• Matching donor and recipient HCV genotypes can enhance the safety of this transplantation strategy.

Conclusions:

• Transplanting kidneys from HCVD-positive donors to HCV-positive recipients is a safe and effective long-term strategy.
• This approach offers superior patient survival compared to remaining on the HCV-positive waitlist.
• Optimizing organ utilization through measures like preemptive transplantation is recommended for surplus HCVD-positive kidneys.