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

  • Potluri VS & al.
  • J Am Soc Nephrol
  • 12 Sep 2019

  • International Clinical Digest
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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.

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