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Kidney Week

Abstract: PO2441

Donor Hepatitis C Antibody Positivity Misclassifies Kidney Donor Profile Index in Non-Hepatitis C-Infected Donors: Time to Revise the Kidney Donor Profile Index

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Yazawa, Masahiko, Methodist University Hospital, Memphis, Tennessee, United States
  • Balaraman, Vasanthi, Methodist University Hospital, Memphis, Tennessee, United States
  • Tsujita, Makoto, Methodist University Hospital, Memphis, Tennessee, United States
  • Azhar, Ambreen, Methodist University Hospital, Memphis, Tennessee, United States
  • Talwar, Manish, Methodist University Hospital, Memphis, Tennessee, United States
  • Bhalla, Anshul, Methodist University Hospital, Memphis, Tennessee, United States
  • Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Eason, James D., Methodist University Hospital, Memphis, Tennessee, United States
  • Molnar, Miklos Zsolt, Methodist University Hospital, Memphis, Tennessee, United States

Group or Team Name

  • Methodist Transplant Epidemiology Research Group
Background

Kidneys from donors with hepatitis C(HCV) infection are traditionally considered to be at risk for poorer graft outcomes, as reflected in the Kidney Donor Profile Index(KDPI). The KDPI defines an HCV positive donor based on HCV antibody(Ab) testing and/or nucleic acid amplification test(NAT), so not actively infected donor is also considered as HCV positive. The outcome of kidneys from HCVAb positive but NAT negative donors are unknown.

Methods

A national-registry-based retrospective cohort study was conducted using the SRTR data set. We identified all HCV negative recipients between April 1st, 2015 and March 2nd, 2018, who received kidney transplant from HCV Ab positive and NAT negative (D-HCVAb(+)/NAT(-) n=116) and HCV Ab negative and NAT negative (D-HCVAb(-)/NAT(-); n=25,574) donor kidneys. We then compared recipients’ estimated glomerular filtration rate(eGFR) at 6 months in matched cohorts, using combined exact matching (based on KDPI) and propensity score matching. We created two separate matched cohorts to examine differences in outcomes based on how HCV positive status is defined: for the first cohort, we used the allocation KDPI (where HCV is considered positive in D-HCVAb(+)/NAT(-)patients), while for the second cohort we used a modified KDPI, where the HCV component of KDPI was considered negative in D-HCVAb(+)/NAT(-)patients.

Results

The mean±SD age of the allocation KDPI matched cohort at baseline was 59±10 years, 69% were male, 61% and 30% of the patients were white and African American, respectively. The baseline characteristics of the recipients were well-balanced in both matched cohorts. Recipients’ eGFR at 6 months after transplantation was significantly higher in the D-HCVAb(+)/NAT (-) group compared to the D-HCVAb(-)/NAT (-) group (61.1±17.9 versus 55.6±18.8 mL/min/1.73m2, p=0.011) in the allocation KDPI matched cohort, while it was similar (61.8±19.5 vs. 62.1±20.1 mL/min/1.73m2, p=0.9) in the modified KDPI matched cohort.

Conclusion

Recipients who received HCVAb positive, but NAT negative donor kidneys did not experience worse 6-month eGFR than correctly matched D-HCVAb (-)/NAT (-) recipients. HCVAb positive, but NAT negative donor kidneys should not be allocated as HCV positive kidneys.