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, 60 (1), 112-20

Impact of Donor Hepatitis C Virus Infection Status on Death and Need for Liver Transplant in Hepatitis C Virus-Positive Kidney Transplant Recipients

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Impact of Donor Hepatitis C Virus Infection Status on Death and Need for Liver Transplant in Hepatitis C Virus-Positive Kidney Transplant Recipients

Lauren M Kucirka et al. Am J Kidney Dis.

Abstract

Background: Only 29% of deceased donor kidney recipients with hepatitis C virus (HCV) receive HCV-positive (HCV+) kidneys. These kidneys are discarded 2.5 times more often than their HCV-negative (HCV-) counterparts, possibly due to the sense that an HCV+ kidney may adversely affect recipient liver function. The goals of this study were to characterize liver disease in HCV+ kidney recipients and compare rates of liver-related outcomes by kidney donor HCV status.

Study design: Observational cohort study.

Setting & participants: 6,250 patients with HCV who had a kidney transplant in 1995-2008 as captured in the United Network for Organ Sharing (UNOS) database. Liver-related outcomes were assessed by cross-linking with the liver waitlist and transplant data sets.

Predictor: HCV status of transplanted kidney.

Outcomes: Joining the liver waitlist, receiving a liver transplant, death.

Measurements: Time to event.

Results: Only 63 (1%) of HCV+ kidney recipients eventually joined the liver waitlist during the 13-year study period. Those who received HCV+ kidneys had a 2.6-fold higher hazard of joining the liver list (P < 0.001); however, the absolute difference in rate of listing between recipients of HCV- and HCV+ kidneys was <2%. This is consistent with findings of only 2% lower patient survival at 3 years in HCV+ patients receiving HCV+ versus HCV- kidneys.

Limitations: We lacked data for HCV viral load and genotype of both HCV+ recipients and transplanted HCV+ kidneys.

Conclusions: Because transplant with an HCV+ kidney may reduce waiting-time by more than a year for an HCV+ patient and there is a high risk of kidney waitlist mortality, a 2% increased rate of adverse liver outcomes and 2% increased rate of death at 3 years should not universally preclude the use of HCV+ kidneys when the intended recipient is also HCV+.

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