Viremic hepatitis C donor kidneys were 48% more likely to be discarded
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Although researchers observed a declining discard rate for kidneys from hepatitis C virus viremic donors over time, organs in 2019 were still 48% more likely to be discarded than those from aviremic seronegative donors.
“Hepatitis C virus (HCV) infection in donors has, historically, been a major driver of organ discards,” Su-Hsin Chang, PhD, of the division of public health sciences, department of surgery, at Washington University School of Medicine in St. Louis, Missouri, and colleagues wrote. “... Since 2014, the use of direct-acting antivirals (DAAs) for HCV treatment has resulted in a cure rate of [greater than] 90%, which has revolutionized the practice for managing HCV infection. Furthermore, DAAs have shown to be safe and efficient in patients with [chronic kidney disease] CKD and kidney transplant recipients. This strategy has helped increase the acceptability of kidneys from donors with HCV infection in many transplant centers, and facilitated their acceptance by patients of CKD.”
To examine contemporary trends of kidney discard from donors with HCV seropositivity and viremia, researchers utilized data from the Organ Procurement and Transplantation Network, including 225,479 kidneys recovered for transplant between 2005 and 2019.
Two comparisons were conducted to “distinguish whether the decline in discard was truly in kidneys from viremic donors,” according to Chang and colleagues.
“Before 2015, HCV was only captured through donor HCV antibody status (HCV seropositive and HCV seronegative), which was the exposure for the first analyses,” the researchers wrote. “The exposure of the second analyses was donor HCV antibody and viremia status: viremic, ie, [nucleic acid amplification testing] NAT positive, regardless of HCV antibody status (HCV seropositive or seronegative); aviremic seropositive; and aviremic seronegative.”
In total, 82,090 kidneys with NAT results were included.
Of total kidneys recovered, Chang and colleagues determined 5% were from HCV seropositive donors, with results showing the odds of HCV seropositive kidney discard gradually declined from an adjusted odds ratio of 7.06 in 2014 to 1.20 in 2019.
Among the kidneys with NAT results, researchers found 4% to be from HCV viremic donors, while 2% were from aviremic seropositive donors. Results of this analysis showed the odds of HCV viremic kidney discard decreased from an adjusted OR of 4.89 in 2018 to 1.48 in 2019.
Further findings showed that by 2018 and 2019, aviremic seropositive status was not associated with higher odds of discard (1.13 vs. 0.97).
“Discard of kidneys from viremic donors has remarkably decreased in the past 3 years,” Chang and colleagues concluded. “There is now equivalent use of kidneys from aviremic seropositive donors and kidneys from aviremic seronegative donors. However, kidneys from viremic donors still had 48% higher odds of discard in 2019. There are opportunities for more transplant centers to utilize these organs to expand access to transplant. Broader utilization would benefit from financial coverage for post-transplant DAAs, which would result in wider adoption of protocols to transplant kidneys from viremic donors to uninfected recipients.”
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