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Published on: July 15, 2015
Survival Benefit in Older Patients Transplanted With Viremic Hepatitis C Positive Kidneys When Compared With High
Lena Sibulesky1,2, Nicolae Leca2,3, Ajit P Limaye2,4
1Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA.
Insights
Kidney transplant candidates with higher estimated posttransplant survival (EPTS) benefit from hepatitis C virus (HCV)-positive kidneys. Acceptance of HCV-positive kidneys for transplantation is increasing, but listing practices require re-evaluation.
Area of Science:
- Nephrology
- Transplantation immunology
- Infectious diseases
Background:
- Increasing demand for kidney transplants leads to consideration of organs with risk criteria, including hepatitis C virus (HCV)-positive kidneys.
- Provider and patient reluctance to accept HCV-positive kidneys persists despite their potential utility.
Purpose of the Study:
- To compare patient and graft survival in kidney transplant recipients who received HCV-positive kidneys versus non-HCV high KDPI kidneys.
- To analyze transplant outcomes based on estimated posttransplant survival (EPTS) groups.
Main Methods:
- Retrospective analysis of the Organ Procurement and Transplantation Network database (May 2013 - June 2021).
- Comparison of adult kidney transplant recipients based on HCV status and KDPI.
- Stratification by EPTS groups (0-20%, 21-60%, >61%).
Main Results:
- HCV-viremic kidneys were transplanted in 5.6% of patients in the EPTS >61% group, 5.1% in the 21%-60% group, and 1.9% in the 0%-20% group.
- In the EPTS >61% group, 11.9% of transplants used KDPI >85% kidneys.
- Patient survival was significantly longer at 1, 3, and 5 years for recipients in the EPTS >61% group who received HCV-viremic or -nonviremic allografts compared to those receiving non-HCV kidneys with KDPI >85%.
Conclusions:
- Findings can inform counseling for kidney transplant candidates regarding kidney acceptance criteria.
- Listing practices for viremic HCV kidneys warrant ongoing re-evaluation to optimize organ utilization.
Background:
Because of the continued demand in kidney transplantation, organs from donors with risk criteria for blood-borne viruses, high Kidney Donor Profile Index (KDPI) kidneys, and hepatitis C virus (HCV)-positive kidneys are being considered. There continues to be reluctance on the part of the providers and the candidates to accept HCV-positive kidneys.
Methods:
We conducted a retrospective analysis of the Organ Procurement and Transplantation Network database of all adult (≥18 y old) recipients undergoing kidney transplant from May 10, 2013, to June 30, 2021. We compared patient and graft survival in candidates who received HCV-positive kidneys versus non-hepatitis C (Hep C) high KDPI kidneys by estimated posttransplant survival (EPTS) groups.
Results:
HCV-viremic kidneys were transplanted in 5.6% of patients in the EPTS >61% group compared with 5.1% of patients in the 21%-60% EPTS group and 1.9% of 0%-20% EPTS group ( P < 0.001). Of all transplants performed in the EPTS 61%-100% group, 11.9% were KDPI >85% compared with 5.2% in the EPTS 21%-60%, and 0.5% in the EPTS 0%-20%. Patient survival was significantly longer at 1, 3, and 5 y in the EPTS >61% group who received Hep C-viremic or -nonviremic allografts compared with non-Hep C kidneys with KDPI >85%. When it comes to listing, only 25% of candidates in the EPTS >61% group were listed for Hep C nucleic acid testing-positive kidneys in 2021.
Conclusions:
Our findings could be used for counseling candidates on the types of kidneys they should consider for transplantation. Also, listing practices for viremic Hep C kidneys need continued re-evaluation.
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