Increasing Access to Kidney Transplantation in an Underserved Population Through a Public-Private Partnership...

Kidney transplantation from Hepatitis C virus (HCV) positive donors to HCV-negative recipients has emerged as a viable strategy to expand the donor pool, made possible by advances in antiviral therapy and post-transplant management. Notably, access to the necessary drug regimen in this study was guaranteed through a public-private partnership with the Washington D.C. municipal government.

In this retrospective cohort study, we analyzed 58 kidney transplant recipients, including 29 HCV-negative patients who received organs from HCV-positive donors and 29 matched controls who received kidneys from HCV-negative donors. Variables collected included metrics detailing time to transplant, donor graft function, and transplant outcomes. Given the small sample size, non-parametric statistical methods were used.

Recipients from HCV-positive donors demonstrated a trend toward shorter waiting times compared to controls (median, 1402 vs. 2276 days; p = .053), with no difference in listing times (p = .785). Donor kidney quality was similar between groups in terms of allograft eGFR (94 vs. 113 mL/min/1.73m², p = .715), cold ischemia time (18.9 vs. 15.7 hours, p = .142), and donor age (32 vs. 34 years, p = .432). Acute rejection rates were similar (34.5% vs. 31.0%; p = .78) as were IFTA scores (0.1 vs. 0.05; p = .37). Allograft loss occurred in 0% of recipients from HCV-positive donors compared to 3.4% in the control group. At one year, patient survival was 100% in both groups.

A novel public-private collaboration allowed us to increase kidney transplantation access in an underserved community through transplantation of kidneys from HCV-positive donors into HCV-negative recipients with trending decreases in wait times, and without differences in graft function and clinical outcomes. Prophylactic direct-acting antiviral therapy (DAAT) allows our patients to never experience hepatitis C viremia. These findings support adoption of innovative healthcare partnerships to broaden access to life-saving therapies, especially as poor patients and marginalized communities continue to have significant obstacles to organ transplantation.