Back to Search
Start Over
Changes in Utilization and Discard of HCV Antibody-Positive Deceased Donor Kidneys in the Era of Direct-Acting Antiviral Therapy.
- Source :
-
Transplantation [Transplantation] 2018 Dec; Vol. 102 (12), pp. 2088-2095. - Publication Year :
- 2018
-
Abstract
- Background: The availability of direct-acting antiviral (DAA) therapy might have impacted use of hepatitis C virus (HCV)-infected (HCV+) deceased donor kidneys for transplantation.<br />Methods: We used 2005 to 2018 Scientific Registry of Transplant Recipients data to identify 18 936 candidates willing to accept HCV+ kidneys and 3348 HCV+ recipients of HCV+ kidneys. We compared willingness to accept, utilization, discard, and posttransplant outcomes associated with HCV+ kidneys between 2 treatment eras (interferon [IFN] era, January 1, 2005 to December 5, 2013 vs DAA era, December 6, 2013 to August 2, 2018). Models were adjusted for candidate, recipient, and donor factors where appropriate.<br />Results: In the DAA era, candidates were 2.2 times more likely to list as willing to accept HCV+ kidneys (adjusted odds ratio, 2.072.232.41; P < 0.001), and HCV+ recipients were 1.95 times more likely to have received an HCV+ kidney (adjusted odds ratio, 1.761.952.16; P < 0.001). Median Kidney Donor Profile Index of HCV+ kidneys decreased from 77 (interquartile range [IQR], 59-90) in 2005 to 53 (IQR, 40-67) in 2017. Kidney Donor Profile Index of HCV- kidneys remained unchanged from 45 (IQR, 21-74) to 47 (IQR, 24-73). After adjustment, HCV+ kidneys were 3.7 times more likely to be discarded than HCV- kidneys in the DAA era (adjusted relative rate, 3.363.674.02; P < 0.001); an increase from the IFN era (adjusted relative rate, 2.783.023.27; P < 0.001). HCV+ kidney use was concentrated within a subset of centers; 22.5% of centers performed 75% of all HCV+ kidney transplants in the DAA era. Mortality risk associated with HCV+ kidneys remained unchanged (aHR, 1.071.191.32 in both eras).<br />Conclusions: Given the elevated risk of death on dialysis facing HCV+ candidates, improving quality of HCV+ kidneys, and DAA availability, broader utilization of HCV+ kidneys is warranted to improve access in this era of organ shortage.
- Subjects :
- Biomarkers blood
Female
Hepatitis C blood
Hepatitis C transmission
Hepatitis C virology
Humans
Male
Middle Aged
Registries
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States
Waiting Lists
Antiviral Agents therapeutic use
Donor Selection
Hepatitis C prevention & control
Hepatitis C Antibodies blood
Kidney Transplantation methods
Patient Acceptance of Health Care
Tissue Donors supply & distribution
Subjects
Details
- Language :
- English
- ISSN :
- 1534-6080
- Volume :
- 102
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 29912046
- Full Text :
- https://doi.org/10.1097/TP.0000000000002323