Transplantation of Kidneys From Hepatitis C Virus-Infected Donors to Hepatitis C Virus-Negative Recipients: One-Year Kidney Allograft Outcomes

Abstract

Rationale & objective: Transplant centers in the United States are increasingly willing to transplant kidneys from hepatitis C virus (HCV)-infected (HCV⁺) donors into HCV^- recipients. We studied the association between donor HCV infection status and kidney allograft function and posttransplantation allograft biopsy findings.

Study design: Retrospective cohort study.

Setting & participants: We examined 65 HCV^- recipients who received a kidney from a HCV⁺ donor and 59 HCV^- recipients who received a kidney from a HCV^- donor during 2018 at a single transplant center.

Exposure: Predictor(s) of donor infection with HCV.

Outcomes: Kidney allograft function and allograft biopsy findings during the first year following transplantation.

Analytical approach: We compared estimated glomerular filtration rate (eGFR), findings on for-cause and surveillance protocol biopsies, development of de novo donor-specific antibodies (DSAs), and patient and allograft outcomes during the first year following transplantation between recipients of HCV⁺ and HCV^- kidneys. We used linear regression to estimate the independent association between allograft function and HCV viremic status of the kidney donor.

Results: The mean age of recipients was 52 ± 11 (SD) years, 43% were female, 19% and 80% of recipients were White and Black, respectively. Baseline characteristics were similar between the HCV⁺ and HCV^- groups. There were no statistically significant differences between the HCV⁺ and HCV^- groups in delayed graft function rates (12% vs 8%, respectively); eGFRs at 3, 6, 9, and 12 months post-transplantation; proportions of patients with cellular rejection (6% vs 7%, respectively); and proportions with antibody-mediated rejection (7% vs 10%, respectively) or de novo DSAs (31% vs 20%, respectively). HCV viremic status was not associated with eGFR at 3, 6, 9, or 12 months.

Limitations: Generalizability from a single-center study and small sample size was limited.

Conclusions: Recipients of kidneys from donors infected with HCV had similar kidney allograft function and probability of rejection in the first year after transplantation compared to those who received kidneys from donors without HCV infection.

Keywords: calculated panel reactive antibodies (cPRA); cytomegalovirus (CMV); direct antiviral agent (DAA); donation after circulatory death (DCD); donor-specific antibodies (DSA); estimated glomerular filtration rate (eGFR); kidney donor profile index (KDPI; nucleic acid test (NAT); polymerase chain reaction (PCR); sustained virologic response (SVR).