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HCV-viremic kidneys provide similar efficacy in recipients as uninfected organs

By 2019, hepatitis C-seronegative patients who underwent kidney transplantation mostly received HCV-viremic donor organs, which demonstrated the same level of function as uninfected kidneys over the course of 1-year follow-up.

Previously, HCV-infected kidneys were often discarded or transplanted only into viremic patients because of the lack of effective antiviral treatment, but the introduction of direct-acting antivirals led to expanded use and improved waitlist outcomes, according to Vishnu S. Potluri, MD, MPH, from the Perelman School of Medicine, University of Pennsylvania, and colleagues.

“Because accepting HCV-viremic kidneys reduced waiting time to transplantation in the past, particularly in regions with long wait times, kidney transplant candidates with chronic HCV infection have often been advised to forego antiviral treatment until after transplantation,” they wrote.

The researchers analyzed kidney transplant data from the Organ Procurement and Transplantation Network between April 2015 and March 2019. During this period, they observed a greater willingness to accept offers of HCV-viremic kidneys for seronegative patients among both transplant candidates (from 1,487 to 2,852) and transplant centers (from 11 to 33).

To determine the efficacy such procedures, Potluri and colleagues matched patients who received uninfected kidneys in a 1:2 ratio with 103 HCV-seronegative recipients of viremic kidneys. At 1 year, HCV-viremic kidney recipients had similar organ function compared with matched recipients (66.8 vs. 66.5 mL/min/1.73 m²).

Similarly, the seronegative patients who received HCV-viremic kidneys had similar estimated glomerular filtration rates as another set of matched patients who were HCV-seropositive at the time of transplantation with HCV-viremic kidneys (65.4 vs. 71.1 mL/min/1.73 m²).

“These striking results provide important additional evidence that the [Kidney Donor Profile Index], with its current negative weightage for HCV status, does not accurately assess the quality of kidneys from HCV-viremic donors,” Potluri and colleagues concluded. “These findings suggest that the benefits of transplantation using HCV-viremic kidneys will be similar if allocated to HCV-seropositive or HCV-seronegative recipients.” – by Talitha Bennett

Disclosures: Potluri reports that he received a Ben J. Lipps grant from the American Society of Nephrology. Please see the full study for all other authors’ relevant financial disclosures.