Short-term outcomes of deceased donor renal transplants of HCV uninfected recipients from HCV seropositive nonviremic donors and viremic donors in the era of direct-acting antivirals.

Abstract

The United States opioid use epidemic over the past decade has coincided with an increase in hepatitis C virus (HCV) positive donors. Using propensity score matching, and the Organ Procurement Transplant Network data files from January 2015 to June 2019, we analyzed the short-term outcomes of adult deceased donor kidney transplants of HCV uninfected recipients with two distinct groups of HCV positive donors (HCV seropositive, nonviremic n=352 and viremic n=196) compared to those performed using HCV uninfected donors (n=36934). Compared to the reference group, the transplants performed using HCV seropositive, nonviremic and viremic donors experienced a lower proportion of delayed graft function (35.2 vs 18.9%;P < .001 [HCV seropositive, nonviremic donors] and 36.2 vs 16.8% ; P < .001[HCV viremic donors]). The recipients of HCV viremic donors had better allograft function at 6months posttransplant (eGFR [54.1 vs 68.3mL/min/1.73m2; P=.004]. Furthermore, there was no statistical difference in the overall graft failure risk at 12months posttransplant by propensity score matched multivariable Cox proportional analysis (HR=0.60, 95% CI 0.23 to 1.29 [HCV seropositive, nonviremic donors] and HR=0.85, 95% CI 0.25to 2.96 [HCV viremic donors]). Further studies are required to determine the long-term outcomes of these transplants and address unanswered questions regarding the use of HCV viremic donors.