Kidney transplants from deceased donors with, without HCV yield similar graft survival
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The 5-year allograft survival of a kidney transplanted from a deceased donor infected with the hepatitis C virus is comparable to a kidney from a donor who is not infected, according to data published in JAMA Network.
Investigators are calling for a reduction in the Kidney Donor Profile Index (KDPI) penalty applied to HCV-infected kidneys as they say these perform as well as a non-infected kidney.
“Before 2016, all of the treatments for HCV involved a drug called Interferon that caused patients to reject transplanted kidneys. In the past, when organs infected with HCV became available, the heart and lungs were almost always discarded, and the kidneys would almost only be given to patients who already had HCV. Most donated kidneys were also thrown away.
So, when new direct-acting antiviral therapy for HCV came out in 2015, we conducted small trials with patients who, for instance, were extremely dissatisfied with being on dialysis, and tried to see if we could give them these organs that were infected with HCV, treat them with the new medicines and observe how they did,” Peter P. Reese, MD, from the Renal Division of the Perelman School of Medicine at the University of Pennsylvania, told Healio. “Those were small trials with short patient follow up. What we haven’t seen in the field are a big group of patients across the country with a follow-up of multiple years.”
To fill that gap in research, Reese and colleagues examined 45,827 deceased donors and 75,905 deceased donor kidney recipients from across the United States between July 1, 2016, and Dec. 31, 2021. Data in the retrospective study were derived from the Organ Procurement and Transplantation Network database.
While seeking to determine if the KDPI HCV penalty remained valid with the use of direct-acting antiviral therapy, researchers compared the 5-year allograft survival between recipients of kidneys from HCV-RNA-positive donors vs. HCV-RNA-negative donors.
Results
A total of 2,551 deceased donors were HCV-RNA-positive, most of which were younger and had better KDPI scores compared with the donors who were not positive. Researchers observed no significant difference in 5-year allograft survival for recipients of HCV-RNA-positive donor kidneys vs. HCV-RNA-negative donor kidneys. They found the 5-year mean allograft survival was 4.30 years for HCV-RNA-positive kidneys vs. 4.27 for HCV-RNA-negative kidneys.
“Our study shows that graft failure rates, at least based on a 5-year period, are equivalent whether the recipient receives an HCV-positive kidney or an HCV-negative kidney,” Douglas E. Schaubel, PhD, from the department of biostatistics, epidemiology and informatics of the Perelman School of Medicine at the University of Pennsylvania, told Healio. “There’s currently a KDPI penalty applied to HCV-positive kidneys that makes it less likely for these organs to be transplanted, because centers think kidneys from HCV-infected donors are low quality. The penalty is approximately 20 points for being a HCV-positive donor. Our immediate hope is that the penalty for HCV will be deleted, which will then decrease the discard rate for these organs.”
Future research
Reese noted that although other studies are exploring kidneys from HCV-positive donors, these are often carefully selected and have short follow-ups.
Currently, Reese and Schaubel are conducting a multicenter trial in which they will focus on long-term complications and kidney function that the present JAMA study could not assess.
“Many transplant centers still do not take kidneys from HCV-positive donors,” Reese said. “A take-home message for nephrologists is to talk to your patients on the transplant waiting list and see if they might consider a transplant from a donor with HCV.”
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