New Study Promotes Kidney Transplantation for HCV Positive Donors

Miklos Z. Molnar, MD, PhD

In the US there has been a push to accept more transplant kidneys from hepatitis C viral (HCV) infected donors for hepatitis C negative recipients.

A team, led by Miklos Z. Molnar, MD, PhD, Associate Professor of Medicine, University of Tennessee Health Science Center James D. Eason Transplant Institute, examined the association of HCV infected donor status with kidney allograft function and post-transplant allograft biopsy findings.

Study Design

In the retrospective cohort study, the investigators examined 65 HCV negative recipients who received a kidney from a positive donor. They also looked at 59 HCV negative recipients who received a kidney from a donor without an HCV infection during 2018 at a single transplant center.

The investigators sought main outcomes of kidney allograft function and allograft biopsy findings during the first-year post transplantation.

The research team compared estimated glomerular filtration rates (eGFR), as well as findings on for-cause and surveillance protocol biopsies, development of de novo donor specific antibodies (DSAs), and patient and allograft outcomes during the first year following transplantation between the 2 arms of the study.

Similar Findings for Liver Transplants

In a separate study, liver donors who are positive for HCV are generally healthier and have superior liver allografts in comparison with HCV-negative donors.

In light of the persistent problem of national organ shortages, it has become imperative to look for means to address this issue and ultimately expand the donor pool. As such, using HCV-positive organs have largely been endorsed as a potential solution to combat this organ shortage.

And yet, despite the increasing awareness as well as advancements in HCV treatment, many HCV-positive liver allografts—as many as several hundred per year—still fail to be used in transplantation.

The Study: Assessing HCV-Positive Versus Negative Donors

Thus, of the 24,500 donors utilized for liver transplantation between June 1, 2015 – December 1, 2018, 1887 (7.7%) of them were HCV antibody positive. Furthermore, 64.4% of HCV-positive donors were HCV nucleic acid test (NAT) positive.

The investigators noted that the HCV antibody positive donors trended towards being younger (median age, 35 years) in comparison with the HCV-negative donors (median age, 40 years).

Additionally, HCV positive donors had fewer comorbidities. For example, in the positive cohort, 8.3% had diabetes—versus 12.0% in the negative cohort (P<.001). Similarly, 25.9% of HCV-positive donors had hypertension, as did 35.2% of HCV-negative donors (P<.001).

Conclusions from the Kidney Study

Overall, there was not a statistically significant difference between the 2 groups in the delayed graft function rates (12% vs 8%), estimated GFRs post-transplant at 3, 6, 9 and 12 months, proportion of patients with cellular rejection (6% vs 7%), and proportion with antibody mediated rejection (7% vs 10%), or de novo DSAs (31% vs 20%).

“Recipients of kidneys from donors infected with HCV have similar kidney allograft function and probability of rejection in the first year after transplantation compared to those who received kidneys from donors without HCV infection,” the authors wrote.

The study, “Transplantation of Kidneys From Hepatitis C Virus–Infected Donors to Hepatitis C Virus–Negative Recipients: One-Year Kidney Allograft Outcomes,” was published online in the American Journal of Kidney Diseases.