The association of donor hepatitis C virus infection with 3-year kidney transplant outcomes in the era of direct-acting antiviral medications

Siobhan Sutcliffe, Mengmeng Ji, Su Hsin Chang, Darren Stewart, David A. Axelrod, Krista L. Lentine, Jason Wellen, Louai Alrata, Gaurav Gupta, Tarek Alhamad

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

To determine the effect of donor hepatitis C virus (HCV) infection on kidney transplant (KT) outcomes in the era of direct-acting antiviral (DAA) medications, we examined 68,087 HCV-negative KT recipients from a deceased donor between March 2015 and May 2021. A Cox regression analysis was used to estimate adjusted hazard ratios (aHRs) of KT failure, incorporating inverse probability of treatment weighting to control for patient selection to receive an HCV-positive kidney (either nucleic acid amplification test positive [NAT+, n = 2331] or antibody positive (Ab+)/NAT− [n = 1826]) based on recipient characteristics. Compared with kidney from HCV-negative donors, those from Ab+/NAT− (aHR = 0.91; 95% confidence interval [CI], 0.75-1.10) and HCV NAT+ (aHR = 0.89; 95% CI, 0.73-1.08) donors were not associated with an increased risk of KT failure over 3 years after transplant. Moreover, HCV NAT+ kidneys were associated with a higher 1-year estimated glomerular filtration (63.0 vs 61.0 mL/min/1.73 m2, P = .007) and lower risk of delayed graft function (aOR = 0.76; 95% CI, 0.68-0.84) compared with HCV-negative kidneys. Our findings suggest that donor HCV positivity is not associated with an elevated risk of graft failure. The inclusion of donor HCV status in the Kidney Donor Risk Index may no longer be appropriate in contemporary practice.

Original languageEnglish (US)
Pages (from-to)629-635
Number of pages7
JournalAmerican Journal of Transplantation
Volume23
Issue number5
DOIs
StatePublished - May 2023

Keywords

  • Organ Procurement and Transplantation Network (OPTN)
  • deceased
  • donors and donation
  • glomerular filtration rate (GFR)
  • graft survival
  • kidney (allograft) function/dysfunction
  • Humans
  • Kidney Transplantation/adverse effects
  • Antiviral Agents/therapeutic use
  • Hepatitis C, Chronic/drug therapy
  • Tissue Donors
  • Hepatitis C
  • Hepacivirus

ASJC Scopus subject areas

  • Transplantation
  • Pharmacology (medical)
  • Immunology and Allergy

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