Low prevalence of glomerulonephritis in transplanted kidneys from deceased donors with active hepatitis C virus infection

Hepatitis C virus (HCV) infection is a leading cause of immune-complex mediated glomerulonephritis, specifically cryoglobulinemic and membranoproliferative glomerulonephritis, and has also been associated with non-glomerular kidney diseases. However, the prevalence of kidney disease among individuals with chronic HCV infection is unknown. Concerns about the quality of kidneys from deceased donors with HCV infection may lead centers to avoid transplanting these organs.

We assembled a multicenter histological database of deceased donor biopsies to compare the prevalence of glomerulonephritis and chronic disease pathology among 147 transplanted kidneys from HCV-RNA⁺ donors matched to 431 HCV-negative donors.

The mean age was 40.3 versus 40.7 years for HCV-RNA⁺ versus HCV-negative donors, respectively. Expert pathology reviews showed that glomerular disease and isolated immune complex deposition were rare in both groups. The primary outcome of glomerulosclerosis, interstitial fibrosis with tubular atrophy, and/or vascular disease was non-inferior (15% margin) for HCV-RNA⁺ versus HCV-negative donor kidneys. Specifically, 61.2% versus 49% had under 5% glomerulosclerosis, 68% versus 58% had under 5% interstitial fibrosis with tubular atrophy, and 46% versus 25% had no vascular disease, for HCV-RNA⁺ versus HCV-negative donor kidneys, respectively. The recipients of kidney transplants from HCV-RNA⁺ donors and HCV-negative comparators both demonstrated good graft function and 12-month eGFR was not significantly different between groups (1.65 ml/min/1.73 m² higher eGFR for HCV-RNA⁺ allograft recipients.) CONCLUSIONS: Our findings indicate that for HCV-RNA⁺ donor kidneys, glomerular disease was rare and chronic disease pathology was not more common than among HCV-negative kidneys, which may reassure clinicians to consider these organs for their patients.