Enhanced Waitlist Outcomes in Transplant Candidates Willing to Accept HCV+ Kidneys

The willingness of hepatitis C RNA-positive (RNA+) waitlisted candidates to accept a kidney from a hepatitis C seropositive donor (HCVD+) was found to have benefits, including an increase in the donor pool, shorter time on the transplant waitlist, higher transplant rates, greater access to deceased donor kidney transplantation, and lower waitlist removal because of death or significant health decline, according to a study recently published in Transplantation.

Hepatitis C seropositive (HCV+) transplant candidates (n=169) were selected from a single-center retrospective analysis and placed on the kidney transplant waitlist at University of California Davis between March 2004 and February 2015. C

andidates were divided into three groups: those who were RNA+ and agreed to HCVD+ inclusion (n=57); those who were RNA+ but not receptive to RNA+ donor inclusion (n=55); and those who were RNA- and waitlisted for transplant from RNA- donors (n=57).

During 6 years of follow-up, 75% (43 of 57) of patients willing to accept from a HCVD+ received a deceased donor kidney transplant, but only 35% (19 of 55) of patients not accepting a HCV+ kidney received a transplant (P < .0001).

The researchers did not find patient and graft survival rates to be significantly different across groups. They conclude that an RNA+ transplant candidate’s willingness to accept an HCVD+ kidney increased the donor pool, shortened the time on the transplant list, increased transplants, gave candidates better access to deceased donor kidney transplantation, lowered waitlist removal rates because of death or significant health decline, and demonstrated better access to transplantation prior to the widespread use of direct-acting, anti HCV agents.

Reference 

Sageshima J, Troppmann C, McVicar JP, Santhanakrishnan C, de Mattos AM, Perez RV. Impact of willingness to accept hepatitis C seropositive kidneys among hepatitis C RNA-positive waitlisted patients. Transplantation. 2018; 102:1179-1187. doi: 10.1097/TP.0000000000002096