The impact of transplantation with deceased donor hepatitis c-positive kidneys on survival in wait-listed long-term dialysis patients.
Whether transplantation of deceased donor kidney allografts from donors with antibodies against hepatitis C virus (HCV) confers a survival advantage compared with remaining on the kidney transplant waiting list is not yet known. We studied 38,270 USRDS Medicare beneficiaries awaiting kidney transplantation who presented with end-stage renal disease from April 1, 1995 to July 31, 2000. Cox regression was used to compare the adjusted hazard ratios for death among recipients of kidneys from deceased donors, and donors with antibodies against hepatitis C (DHCV+), controlling for demographics and comorbidities. In comparison to staying on the waiting list, transplantation from DHCV+ was associated with improved survival among all patients (adjusted hazard ratio for death 0.76, 95% CI 0.60, 0.96). Of patients receiving DHCV+ kidneys, 52% were themselves hepatitis C antibody positive (HCV+), so outcomes associated with use of these grafts may have particular implications for HCV+ transplant candidates. Recommendations for use of DHCV+ kidneys may require analysis of data not currently collected from either dialysis or transplant patients. However, transplantation of DHCV+ kidneys is associated with improved patient survival compared to remaining wait-listed and dialysis dependent.
Abbott
Kevin C
KC
Nephrology Service, Walter Reed Army Medical Center, Washington, D.C., USA. kevin.abbott@na.amedd.army.mil
Lentine
Krista L
KL
Bucci
Jay R
JR
Agodoa
Lawrence Y
LY
Peters
Thomas G
TG
Schnitzler
Mark A
MA
D000368:Aged; D016208:Databases, Factual; D006526:Hepatitis C / Q000635:transmission*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D006278:Medicare; D016019:Survival Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data* / Q000600:supply & distribution; D016896:Treatment Outcome; D014481:United States; D014850:Waiting Lists