Is It Time to Transplant Hepatitis C Positive Kidneys in Hepatitis C Negative Patients in the Era of Direct-Acting Antiviral Agents in New York State?

Abstract

Introduction: To provide a risk-benefit analysis for donating Hepatitis C virus (HCV) positive kidneys to HCV-negative recipients in an attempt to increase the donor pool and reduce the time to transplant.Figure 1Methods: We reviewed current literature looking at (i) the efficacy of treatment for HCV post-transplant with direct-acting antiviral agents (DAAs) and (ii) post-transplant complications associated with HCVpositive donor kidneys. Waitlist times and donor pool were compared analyzed. We also weighed the reduction of time on the waitlist against post-transplant graft survival to create a model to predict the potential benefit of transplanting HCV-positive kidneys. Results: There were 317 deceased kidney donors in 2015 with 8,261 recipient candidates on the waitlist for kidney transplantation. The median waiting time was approximately 4.57 years based on the 2009 data. Our model concludes that HCV-negative patients on the waitlist for kidney transplantation can expect a 12.58% greater survival rate 5 years post-transplant if a HCV-positive donor kidney is accepted compared to an HCV-negative donor kidney. Also based on the prevalence data depicting 3.45% of HCV in potential organ donors and 317 deceased kidney donors in NY in 2015, the use of the additional 6 HCV(+) donor organs wasted each year will result in a modest decrease in time on waitlist of approximately 1 month for all HD patients awaiting deceased organ transplant Conclusion: Treatment of HCV with DAAs is so recent that there are currently no data demonstrating post-transplant survival rates of HCV-negative patients receiving HCV-positive kidneys. However, multiple studies have demonstrated tremendous efficacy and safety profiles associated with post-transplant treatment of HCV with DAAs. Also, the waitlist times for organ transplant are highly center specific and at certain centers the recipients could see a reduction in wait time of nearly one year. Further research is certainly needed to understand the interactions of DAAs with immunosuppressants and its effect on graft survival and glomerulonephritis.