title: Impact of donor hepatitis C virus infection status on death and need for liver transplant in hepatitis C virus-positive kidney transplant recipients.
abstract: BACKGROUND
  Only 29% of deceased donor kidney recipients with hepatitis C virus (HCV) receive HCV-positive (HCV+) kidneys. These kidneys are discarded 2.5 times more often than their HCV-negative (HCV-) counterparts, possibly due to the sense that an HCV+ kidney may adversely affect recipient liver function. The goals of this study were to characterize liver disease in HCV+ kidney recipients and compare rates of liver-related outcomes by kidney donor HCV status.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  6,250 patients with HCV who had a kidney transplant in 1995-2008 as captured in the United Network for Organ Sharing (UNOS) database. Liver-related outcomes were assessed by cross-linking with the liver waitlist and transplant data sets.
  
  
  METHODS
  HCV status of transplanted kidney.
  
  
  RESULTS
  Joining the liver waitlist, receiving a liver transplant, death.
  
  
  METHODS
  Time to event.
  
  
  RESULTS
  Only 63 (1%) of HCV+ kidney recipients eventually joined the liver waitlist during the 13-year study period. Those who received HCV+ kidneys had a 2.6-fold higher hazard of joining the liver list (P < 0.001); however, the absolute difference in rate of listing between recipients of HCV- and HCV+ kidneys was <2%. This is consistent with findings of only 2% lower patient survival at 3 years in HCV+ patients receiving HCV+ versus HCV- kidneys.
  
  
  CONCLUSIONS
  We lacked data for HCV viral load and genotype of both HCV+ recipients and transplanted HCV+ kidneys.
  
  
  CONCLUSIONS
  Because transplant with an HCV+ kidney may reduce waiting-time by more than a year for an HCV+ patient and there is a high risk of kidney waitlist mortality, a 2% increased rate of adverse liver outcomes and 2% increased rate of death at 3 years should not universally preclude the use of HCV+ kidneys when the intended recipient is also HCV+.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Kucirka
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Peters
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification; D006526:Hepatitis C / Q000453:epidemiology*; D006801:Humans; D066298:In Vitro Techniques; D007668:Kidney / Q000821:virology*; D007674:Kidney Diseases / Q000453:epidemiology* / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology; D008107:Liver Diseases / Q000453:epidemiology* / Q000601:surgery / Q000821:virology; D016031:Liver Transplantation / Q000276:immunology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D014019:Tissue Donors; D014850:Waiting Lists