Update: HCV-infected donor kidneys functioning well at 1 year

Takeaway

• HCV-infected and noninfected kidneys yield similar renal function at 1 year.
• Recipient HCV status does not affect graft function in the direct-acting antiviral (DAA) era.

Why this matters

• Although the authors support updating the kidney donor profile index (KDPI) based on allograft function, John Gill, MD, describes the idea as "premature" in an accompanying editorial.

Study design

• Organ Procurement and Transplantation Network kidney transplant data from April 2015 through March 2019.
• 103 HCV-negative recipients of HCV+ kidneys were highly matched 1:2 with other populations.
• Funding: Health Resources and Services Administration.  

Key results

• Over 4 years, 1862 HCV+ kidneys were transplanted, 1199 discarded, and 892 not recovered.
  • Number of wait-listed patients willing to accept a viremic kidney rose from 2936 to 16,809.
• In January-March 2019, 269 HCV+ kidneys were transplanted; only 105 were discarded.
  • More recipients were HCV-negative vs positive (200 vs 69).
• In HCV-negative recipients, HCV+ and -negative kidneys yielded similar 1-year estimated glomerular filtration rate (eGFR, in mL/minute/1.73 m²: 66.8 vs 66.5; P=.80), despite much lower KDPI scores.
  • Median time to transplant was shorter with viremic grafts (239 vs 619 days).
• HCV+ kidneys also yielded similar 1-year eGFR in HCV-negative vs HCV+ recipients (65.4 vs 71.1; P=.05).

Limitations

• HCV genotype, DAA regimens/outcomes were not captured.