Center-level trends in utilization of HCV-exposed donors for HCV-uninfected kidney and liver transplant recipients in the United States

Am J Transplant. 2019 Aug;19(8):2329-2341. doi: 10.1111/ajt.15355. Epub 2019 Apr 9.


Several single-center reports of using HCV-viremic organs for HCV-uninfected (HCV-) recipients were recently published. We sought to characterize national utilization of HCV-exposed donors for HCV- recipients (HCV D+/R-) in kidney transplantation (KT) and liver transplantation (LT). Using SRTR data (April 1, 2015-December 2, 2018) and Gini coefficients, we studied center-level clustering of 1193 HCV D+/R- KTs and LTs. HCV-viremic (NAT+) D+/R- KTs increased from 1/month in 2015 to 22/month in 2018 (LTs: 0/month to 12/month). HCV-aviremic (Ab+/NAT-) D+/R- KTs increased from < 1/month in 2015 to 26/month in 2018 (LTs: <1/month to 8/month). HCV- recipients of viremic and aviremic kidneys spent a median (interquartile range [IQR]) of 0.7 (0.2-1.6) and 1.6 (0.4-3.5) years on the waitlist versus 1.8 (0.5-4.0) among HCV D-/R-. HCV- recipients of viremic and aviremic livers had median (IQR) MELD scores of 24 (21-30) and 25 (21-32) at transplantation versus 29 (23-36) among HCV D-/R-. 12 KT and 14 LT centers performed 81% and 76% of all viremic HCV D+/R- transplants; 11 KT and 13 LT centers performed 76% and 69% of all aviremic HCV D+/R- transplants. There have been marked increases in HCV D+/R- transplantation, although few centers are driving this practice; centers should continue to weigh the risks and benefits of HCV D+/R- transplantation.

Keywords: Organ Procurement and Transplantation Network (OPTN); Scientific Registry for Transplant Recipients (SRTR); clinical research/practice; hepatitis C; infection and infectious agents - viral; infectious disease; kidney transplantation/nephrology; liver transplantation/hepatology.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Antiviral Agents / therapeutic use
  • Female
  • Follow-Up Studies
  • Hepacivirus / isolation & purification
  • Hepatitis C / drug therapy
  • Hepatitis C / virology*
  • Humans
  • Kidney Transplantation / methods*
  • Liver Transplantation / methods*
  • Male
  • Middle Aged
  • Practice Patterns, Physicians' / standards
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Practice Patterns, Physicians' / trends*
  • Prognosis
  • Tissue Donors / supply & distribution*
  • Tissue and Organ Procurement / statistics & numerical data*
  • Transplant Recipients
  • Waiting Lists


  • Antiviral Agents