National Trends in Utilization and 1-Year Outcomes with Transplantation of HCV-Viremic Kidneys

Significance Statement HCV-viremic kidneys are assessed as worse quality using the kidney donor profile index, which has led to many of these organs being discarded. Until 2015, HCV-viremic kidneys were almost exclusively transplanted into recipients with preexisting HCV infection. Since the advent of direct-acting HCV treatments, small trials of transplanting HCV-viremic kidneys into recipients without HCV and then treating them have had positive results. Using United States registry data, the authors show that there has been a dramatic increase in the transplantation of HCV-viremic kidneys into recipients without HCV infection since 2015. They also show that HCV-viremic kidney recipients have excellent kidney function at 12-months post-transplant. Yet, many HCV-viremic kidneys are still being discarded. In summary, kidneys from donors with HCV viremia function well despite adverse quality assessment and are a valuable resource for transplant candidates with or without HCV. Background Recent pilot trials have demonstrated the safety of transplanting HCV-viremic kidneys into HCV-seronegative recipients. However, it remains unclear if allograft function is impacted by donor HCV-viremia or recipient HCV-serostatus. Methods We used national United States registry data to examine trends in HCV-viremic kidney use between 4/1/2015 and 3/31/2019. We applied advanced matching methods to compare eGFR for similar kidneys transplanted into highly similar recipients of kidney transplants. Results Over time, HCV-seronegative recipients received a rising proportion of HCV-viremic kidneys. During the first quarter of 2019, 200 HCV-viremic kidneys were transplanted into HCV-seronegative recipients, versus 69 into HCV-seropositive recipients, while 105 HCV-viremic kidneys were discarded. The probability of HCV-viremic kidney discard has declined over time. Kidney transplant candidates willing to accept a HCV-seropositive kidney increased from 2936 to 16,809 from during this time period. When transplanted into HCV-seronegative recipients, HCV-viremic kidneys matched to HCV-non-viremic kidneys on predictors of organ quality, except HCV, had similar 1-year eGFR (66.3 versus 67.1 ml/min per 1.73 m 2 , P =0.86). This was despite the much worse kidney donor profile index scores assigned to the HCV-viremic kidneys. Recipient HCV-serostatus was not associated with a clinically meaningful difference in 1-year eGFR (66.5 versus 71.1 ml/min per 1.73 m 2 , P =0.056) after transplantation of HCV-viremic kidneys. Conclusions By 2019, HCV-seronegative patients received the majority of kidneys transplanted from HCV-viremic donors. Widely used organ quality scores underestimated the quality of HCV-viremic kidneys based on 1-year allograft function. Recipient HCV-serostatus was also not associated with worse short-term allograft function using HCV-viremic kidneys.