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Utilization of Organs From Donors According to Hepatitis C Antibody and Nucleic Acid Testing Status: Time for Change
C E Kling1, J D Perkins1, C S Landis2
1Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA.
Insights
Hepatitis C virus (HCV) antibody positive and NAT negative donors can increase organ utilization. Utilizing these donors could yield significantly more kidney, heart, and lung transplants annually.
Area of Science:
- Transplantation
- Infectious Disease
- Organ Donation
Background:
- Hepatitis C virus (HCV) antibody (Ab) and nucleic acid testing (NAT) status impact organ utilization.
- Recent implementation of routine donor HCV NAT necessitates re-evaluation of donor criteria.
Purpose of the Study:
- To determine the impact of HCV Ab and NAT status on organ utilization.
- To assess the potential increase in organ donor numbers by utilizing specific HCV-positive donor groups.
Main Methods:
- Analysis of 9290 donors from the United Network for Organ Sharing database (2015-2016).
- Comparison of organ utilization rates based on HCV Ab and NAT status (Ab-NAT-, Ab-NAT+, Ab+NAT-, Ab+NAT+).
- Propensity score-matched modeling to estimate potential increases in organ donors.
Main Results:
- Ab-NAT- donors had the highest utilization for most organs.
- Ab+NAT- donors showed higher liver utilization (81.2% vs 73.2%).
- Kidney discards were linked to HCV status in Ab- or NAT-positive donors.
Conclusions:
- HCV Ab+NAT- donors are underutilized but offer significant potential for increasing organ availability.
- Optimizing the use of Ab+NAT- donors could lead to hundreds of additional kidney, heart, and lung transplants annually.
- Careful selection and recipient consent are crucial for utilizing HCV Ab+NAT- donors.
Abstract:
Previous studies have grouped all donors positive for hepatitis C virus (HCV) antibody (Ab). Only recently has donor HCV nucleic acid testing (NAT) become routine, and the impact of Ab and NAT status on organ utilization is unknown. Using the United Network for Organ Sharing database, we identified 9290 donors from 2015 to 2016 for whom both HCV Ab and NAT data were available and compared organ utilization by HCV status. Overall, 93.8% of donors were Ab negative and NAT negative (Ab-NAT-), 0.15% were Ab negative and NAT positive, 1.8% were Ab positive and NAT negative (Ab+NAT-), and 4.2% were both Ab and NAT positive (Ab+NAT+). Ab-NAT- donors donated at the highest rate for all organs except livers, of which Ab+NAT- donors donated at a higher rate (81.2% vs 73.2%, p = 0.03). Livers were discarded for reasons related to abnormal biopsies in Ab+NAT+ donors, whereas kidneys from Ab- or NAT-positive donors were discarded for reasons related to HCV status. Using a propensity score-matched model, we estimated that using Ab+NAT- donors at the same rate as Ab-NAT- donors could result in 48 more kidney donors, 37 more heart donors, and 15 more lung donors annually. We urge the use of HCV Ab+NAT- donors for appropriately selected and consenting recipients.
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