Survey Finds Many Patients Willing to Accept HCV-Infected Kidney for Transplantation

November 20, 2020
Jonathan Alicea

The shortage of kidney donors begs a need to consider safe approaches to expand the donor pool.

According to a new survey, a majority of kidney transplant waitlist patients indicated that utilization of Hepatitis C virus (HCV)-infected kidneys is acceptable.

However, only a few patients indicated comfortability with kidney offers from donors at high-risk for other conditions, like diabetes and hypertension.

Recent years have been marked by critical shortages in kidney donors—therefore, these findings underscore the importance of safely expanding the donor pool to address this issue.

A team, led by Gretchen Edwards, MD, Department of General Surgery, Vanderbilt University Medical Center, administered an anonymous, electronic survey to waitlist patients in order to compare willingness to accept HCV-infected kidney as well as identify any clinical characteristics associated with such willingness.

“Despite the growing interest in the transplant community to broadly adopt the practice of transplanting HCV-infected kidneys into uninfected recipients, little is known about patient willingness to accept such kidneys and how this compares to willingness to accept other “non-standard” kidneys such as PHS increased risk and high kidney donor profile index (KDPI),” they wrote.

All patients who received the survey (n = 435) were registered at a large volume transplant center in Nashville, TN. The team noted that no pilot survey was conducted at the study’s initiation.

They provided patients with introductory information to the survey, which included observed HCV cure with current DDA therapy. Further, they were queried for demographic information, dialysis time, type of dialysis, and history of prior kidney treatment.

The survey asked them to indicate their willingness to 3 hypothetical kidney offers:

  1. 20-year-old HCV-infected donor with a greater than 95% chance of successful HCV cure following transplant.
  2. 20-year-old PHS-increased risk donor with active Intravenous drug use (IVDU) at time of death.
  3. 70-year-old donor with long-standing hypertension and diabetes.

The recorded response rate was 29%, with the mean age of responders being 55 years of age. Of the population, 57% were male, 66% were white, and 28% were black.

Further, 70% were on dialysis, with the majority (66%) undergoing hemodialysis.

Thus, as many as 69% of the respondents indicated a willingness to accept an HCV-infected kidney. According to the unadjusted analysis, these patients trended towards a significantly older population (mean age, 57 years for willing versus 51 years for unwilling).

However, a multivariate logistic regression analysis revealed that neither age (OR 1.03, 95% CI 0.99–1.07) nor race (OR 0.63, 95% CI 0.24–1.68) was associated with willingness following adjustment of sex, time on dialysis, or educational status. 

And yet, they noted these findings were contrary to prior studies, some of which have found a greater willingness among older patient and white patients.

Additionally, only 37% of patients indicated willingness to accept a kidney from active IVDU at the time of death. Similarly, 39% of patients were willing to accept an offer from older donors with a long-standing history of diabetes and hypertension.

“For those patients who reported ‘no’ to any organ offer and were subsequently asked to respond to how much additional time they would be willing to wait in order to receive a ‘standard’ kidney offer, those who declined an HCV-infected kidney were willing to wait for a mean additional time of 3.5 years,” the investigators wrote.

In regard to the overall findings, they suggested that patients still lack clarity in outcomes associated with other types of “high-risk” donations.

“Given these data and other groups’ findings that patients prominently consider the opinion of the transplant provider in whether or not to accept an organ offer, we suggest that providers carefully consider the risks and benefits of an organ offer with their patients,” Edwards and colleagues noted.

“These discussions should include consideration of patient age, current quality of life, and ability to detect and treat potentially transmitted infections,” they wrote.

The study, “Exploring patient willingness to accept hepatitis C-infected kidneys for transplantation,” was published online in BMC Nephrology.