Long term Outcomes and Transmission Rates in Hepatitis C Virus Positive Donor to Hepatitis C Virus Negative Kidney Transplant Recipients: Analysis of United States National Data

The use of kidneys from hepatitis C virus (HCV) positive (D+) deceased donors for HCV negative recipients (R-) might increase the donor pool. We analyzed the national OPTN registry from 1994-2014 to compare the outcomes of HCV D+/R- (n=421) to propensity matched HCV donor negative (D-)/R- kidney transplants, as well as with, wait listed patients who never received a transplant, in a 1:5 ratio (n = 2105, per matched group). Both 5-year graft (44% vs. 66%; p < 0.001) and patient survival (57% vs. 79%; p < 0.001) were inferior for D+/R- group compared to D-/R-. Nevertheless, five-year patient survival from the time of wait listing was superior for D+/R- when compared to wait listed controls (68% vs. 43%; p<0.001). Of the 126 D+/R- with available post-transplant HCV testing, HCV seroconversion was confirmed in 62 (49%), likely donor-derived. Five-year outcomes were similar between D+/R- that seroconverted vs. D+/R- that did not (n = 64). Our analysis shows inferior outcomes for D+/R- patients although detailed data on pre-transplant risk factors was not available. Limited data suggests that HCV transmission occurred in half of HCV D+/R- patients, although this might not have been the primary factor contributing to the poor observed outcomes. This article is protected by copyright. All rights reserved.