Effect of Recipient Hepatitis C Status on the Outcome of Deceased Donor Kidney Transplantation

Abstract Background Hepatitis C virus (HCV) infection has been deemed detrimental to kidney transplantation (KT) outcome. Breakthrough HCV treatment with direct-acting antiviral (DAA) medications improved the probability of HCV+ utilization for KT even in non-infected (HCV-) recipients. We hypothesized that recipient HCV infection influences deceased donor KT outcome; and this effect could be modified by donor HCV status, and DAAs use. Study Design We conducted a retrospective cohort study based on data from the Organ Procurement and Transplantation Network (OPTN) as of September 2018. A mate kidneys analysis was performed with HCV+ and HCV- recipients of solitary adult KT from ABO-compatible deceased donor between Jan 1994, and Jun 2018. We selected donors where one KT recipient was HCV+, and the mate kidney recipient was HCV-. Both HCV- and HCV+ donors were identified and analyzed as separate. Outcomes including survival of patients, grafts and death-censored grafts (DCGS) were compared between the groups. Results 425 HCV+ and 5,575 HCV- donor’s mate kidneys were transplanted in HCV discrepant recipient. HCV+ recipients of HCV- donor had worse patient and graft survival (aHR: 1.191.281.37, 1.181.261.34, respectively) and DCGS (aHR: 1.151.241.34) compared to HCV- recipients. Comparable patient and graft survival, and DCGS were found in recipients of HCV+ donors, regardless of recipient HCV status. The risk associated with HCV positivity in donors or recipients in the pre-DAA era (before Dec 2013) was no longer statistically significant in the post-DAA era. Conclusion Given comparable outcomes between HCV+ and HCV- recipients in post DAA era or when receiving HCV+ donor kidneys, broader utilization of HCV+ kidneys regardless of the recipient’s HCV status should be advocated, and allocation algorithm for HCV+ kidneys should be revised.