Underutilization of hepatitis C-positive kidneys for hepatitis C-positive recipients.
Hepatitis C-positive (HCV(+)) candidates likely derive survival benefit from transplantation with HCV(+) kidneys, yet evidence remains inconclusive. We hypothesized that lack of good survival benefit data has led to wide practice variation. Our goal was to characterize national utilization of HCV(+) kidneys for HCV(+) recipients, and to quantify the risks/benefits of this practice. Of 93,825 deceased donors between 1995 and 2009, HCV(+) kidneys were 2.60-times more likely to be discarded (p < 0.001). However, of 6830 HCV(+) recipients, only 29% received HCV(+) kidneys. Patients over 60 relative rate (RR 0.86), women (RR 0.73) and highly sensitized patients (RR 0.42) were less likely to receive HCV(+) kidneys, while African Americans (RR 1.56), diabetics (RR 1.29) and those at centers with long waiting times (RR 1.19) were more likely to receive them. HCV(+) recipients of HCV(+) kidneys waited 310 days less than the average waiting time at their center, and 395 days less than their counterparts at the same center who waited for HCV(-) kidneys, likely offsetting the slightly higher patient (HR 1.29) and graft loss (HR 1.18) associated with HCV(+) kidneys. A better understanding of the risks and benefits of transplanting HCV(+) recipients with HCV(+) kidneys will hopefully improve utilization of these kidneys in an evidence-based manner.
Kucirka
L M
LM
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Singer
A L
AL
Ros
R L
RL
Montgomery
R A
RA
Dagher
N N
NN
Segev
D L
DL
D001741:Black or African American / Q000706:statistics & numerical data; D005260:Female; D016174:Hepacivirus; D006526:Hepatitis C / Q000635:transmission*; D006801:Humans; D007668:Kidney; D018570:Risk Assessment; D014019:Tissue Donors