Impact of Willingness to Accept Hepatitis C Seropositive Kidneys Among Hepatitis C RNA-Positive Waitlisted Patients

Abstract

Background: Kidney transplantation from hepatitis C seropositive (HCV+) donors may benefit hepatitis C RNA-positive (RNA+) candidates, but it is unclear how the willingness to be listed for and accept such kidneys affects waitlist and transplant outcomes.

Methods: In a single-center retrospective analysis, HCV+ transplant candidates (N = 169) listed from March 2004 to February 2015 were evaluated. All RNA+ candidates were offered the option to be listed for HCV+ donors. RNA- candidates were listed only for HCV- donors.

Results: Fifty-seven patients (51% of all RNA+ transplant candidates) willing to accept HCV+ donors were listed for both HCV+ and HCV- donor kidneys. During 6-year follow up, 43 (75%) of 57 patients accepting HCV+ versus 19 (35%) of 55 patients not accepting HCV+ received a deceased donor kidney transplant (P < 0.0001). Multivariable analysis demonstrated that willingness to be listed for and accept HCV+ kidneys was associated with receiving deceased donor kidney transplant (P = 0.0016). Fewer patients accepting HCV+ donors (7 [12%] vs 16 [29%]) were removed from the list due to death or deteriorated medical condition (P = 0.0117). Posttransplant patient and graft survival rates were not significantly different. Overall patient survival since the listing (combined waitlist and posttransplant survival) was similar among the groups.

Conclusions: HCV RNA+ candidates had better access to transplantation and similar overall survival before the era of widespread use of direct-acting anti-HCV agents.

FIGURE 1.

Flow chart of study group allocation. HCV antibody-positive candidates were tested for HCV RNA. Candidates who were HCV RNA-positive and willing to accept a kidney graft from a HCV-positive donor were listed for both HCV-positive and HCV-negative donor kidneys; the remaining candidates were listed only for HCV-negative donor kidneys.

FIGURE 2.

DDKT and waitlist removal rates among waitlisted patients. Group Y: HCV RNA-positive candidates who were listed for both HCV-positive and -negative donor kidneys. Group N: HCV RNA-positive candidates who were listed for only HCV-negative donor kidneys. Group C: HCV RNA-negative or unknown candidates who were listed for only HCV-negative donor kidneys. A, Cumulative incidence of transplant events (P < 0.0001 comparing the 3 groups and P < 0.0001 comparing group Y vs group N). B, Cumulative incidence of removal due to death or medical deterioration (P = 0.0286 comparing the 3 groups and P = 0.0117 comparing group Y vs group N).

FIGURE 3.

Posttransplant patient and graft survival. A, Posttransplant patient survival (P = 0.2863 comparing group Y vs group N). B, Graft survival (without censoring death with functioning graft, P = 0.1375 comparing group Y vs group N). C, Death-censored graft survival (P = 0.2487 comparing group Y vs group N).

FIGURE 4.

Overall patient survival. The patients were followed throughout pretransplant (waitlist) and posttransplant since listing (P = 0.9037 comparing the 3 groups and P = 0.6632 comparing group Y vs group N).