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Kidney Week

Abstract: TH-PO910

Impact of Recipient Hepatitis C Virus (HCV) Sero-Status on the Outcomes Following Kidney Transplantation from HCV Viremic Donors in the Era of Directly Acting Anti-HCV Agent Use

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical

Authors

  • Sureshkumar, Kalathil K., Allegheny Health Network, Pittsburgh, Pennsylvania, United States
  • Chopra, Bhavna, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • McGill, Rita L., University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
Background

Kidneys from hepatitis C virus (HCV) infected donors were historically utilized for transplantation into HCV seropositive recipients and in recent years with the availability of highly effective directly acting anti-HCV (DAA) agents into HCV-naive recipients. We aimed to look at the trend in the use of kidneys from HCV infected donors stratified by recipient HCV sero-status and compared transplant outcomes with respect to recipient HCV sero-status.

Methods

OPTN/UNOS files were used to identify all HCV viremic donors for whom each kidney was transplanted into a first-time kidney-only recipient with a known HCV sero-status from 01/2015 to 12/2022. Length of stay (LOS), delayed graft function (DGF), time to death and graft failure were assessed. Marginal models with robust sandwich estimators were used to account for clustering by donor, allowing odds ratio (OR) for DGF and hazard ratios (HR) for graft failure, death-censored graft failure and death to be calculated within a mate-kidney frame work. Models were adjusted for multiple recipient and transplant related variables.

Results

Median study follow up was 22 (10-35) months. There were 3524 recipients of matched HCV+ donor kidneys and 80.5% of recipients were HCV-. There was an increase in HCV+ donor kidney availability over time from 116 in 2015 to 614 in 2022. HCV+ to HCV- transplantation increased from 6% of all kidneys in 2015 to 95% in 2022. LOS was similar for HCV+ [5 days (4-6)] vs. HCV- [4 days (3-6)] recipients (p=0.7).Transplant outcomes for HCV+ (n=688) vs. HCV- (n=2836) recipients are shown in the table.

Conclusion

Our analysis showed increasing utilization of HCV+ (viremic) kidneys over time with preferential use in HCV- recipients more recently. Similar graft and patient outcomes of HCV+ kidney transplantation into HCV+ vs. HCV- recipients likely reflect availability of DAA agent. Our study demonstrates reduced accessibility of HCV+ kidneys for HCV+ recipients in recent years despite equivalent outcomes.

OutcomeUnivariateAdjusted
 OR (95% CI)POR (95% CI)P
Delayed graft function1.32 (0.83-2.11)0.21.25 (0.72-2.17)0.4
 HR (95% CI)PHR (95% CI)P
Graft failure0.86 (0.68-1.56)0.20.81 (0.62-1.04)0.1
Death-censored graft failure1.08 (0.70-1.66)0.70.98 (0.62-1.54)0.9
Death0.82 (0.64-1.05)0.10.81 (0.61-1.07)0.1