Secondary Logo

Institutional members access full text with Ovid®

Share this article on:

Race, Risk, and Willingness of End-Stage Renal Disease Patients Without Hepatitis C Virus to Accept an HCV-Infected Kidney Transplant

McCauley, Maureen, BS1; Mussell, Adam, MA1; Goldberg, David, MD, MSCE1,2; Sawinski, Deirdre, MD3; Molina, Rodolfo, N., MD4; Tomlin, Ricarda, BA4; Doshi, Sahil, D., BA5; Abt, Peter, MD6; Bloom, Roy, MD3; Blumberg, Emily, MD7; Kulkarni, Sanjay, MD4; Esnaola, Gabriela8; Shults, Justine, PhD1; Thiessen, Carrie, MD, PhD4; Reese, Peter, P., MD, MSCE1,3,9,10

doi: 10.1097/TP.0000000000002099
Original Clinical Science—General

Background Despite effective antiviral treatment, hundreds of kidneys from deceased donors with hepatitis C virus (HCV) are discarded annually. Little is known about the determinants of willingness to accept HCV-infected kidneys among HCV-negative patients.

Methods At 2 centers, 189 patients undergoing initial or reevaluation for transplant made 12 hypothetical decisions about accepting HCV-infected kidneys in which we systematically varied expected HCV cure rate, allograft quality, and wait time for an uninfected kidney.

Results Only 29% of the participants would accept an HCV-infected kidney under all scenarios, whereas 53% accepted some offers and rejected others, and 18% rejected all HCV-infected kidneys. Higher cure rate (odds ratio [OR], 3.49; 95% confidence interval [CI], 2.33-5.24 for 95% vs 75% probability of HCV cure), younger donor (OR, 2.34; 95% CI, 1.91-2.88 for a 20-year-old vs a 60-year-old hypertensive donor), and longer wait for an uninfected kidney (OR, 1.43; 95% CI, 1.22-1.67 for 5 years vs 2 years) were associated with greater willingness to accept an HCV-infected kidney. Black race modified the effect of HCV cure rate, such that willingness to accept a kidney increased less for blacks versus whites as the cure rate improved. Patients older than 60 years and prior kidney recipients showed greater willingness to accept an HCV-infected organ.

Conclusions Most patients will consider an HCV-infected kidney in some situations. Future trials using HCV-infected kidneys may enhance enrollment by targeting older patients and prior transplant recipients, but centers should anticipate that black patients’ acceptance of HCV-infected kidneys will be reduced compared with white patients.

With the availability of very efficient anti-hepatis C virus treatments, the authors ask 189 potential kidney recipients to answer various scenarios about acceptance of a HCV+ donor kidney. Age, race, and rank of transplantation are important factors in accepting such kidneys that are currently discarded.

1 Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

2 Gastroenterology Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

3 Renal-Electrolyte and Hypertension Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

4 Department of Surgery, Yale School of Medicine, New Haven, CT.

5 University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

6 Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

7 Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

8 Yale University, New Haven, CT.

9 Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

10 Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA.

Received 20 August 2017. Revision received 14 November 2017.

Accepted 2 December 2017.

P.R.P and D.G. have received research grant support from Merck to the University of Pennsylvania for the conduct of clinical trials in transplantation involving the use of organs from HCV-infected deceased donors. G.E.'s efforts were supported by a grant from the SUMR program at the Leonard Davis Institute at the University of Pennsylvania.

D.S. has consulted for Merck on an advisory board for the drug Zepatier.

M.M.C. and AM. contributed equally to the work.

M.M. collected data, interpreted results, and drafted the article. A.M. collected data, interpreted results, and drafted the article. D.G. contributed to study design, interpreted results, critical editing of manuscript. D.S. interpreted results, critical editing of the article. R.M. collected data. R.T. collected data. S.D. collected data, interpreted results, drafted the article. P.A. interpreted results, critical editing of the article. R.B. interpreted results, critical editing of the article. E.B. interpreted results, critical editing of the article. S.K. coordinated data collection, interpreted results, critical editing of the article. G.E. collected data, interpreted results. J.S. statistical analysis, interpreted results, critical editing of the article. C.T. coordinated data collection, interpreted results, critical editing of the article. P.R. designed study, interpreted results, statistical analysis, drafted and edited the article.

Correspondence: Peter P. Reese, MD, MSCE, Center for Clinical Epidemiology and Biostatistics 917, Blockley Hall 423, Guardian Dr, Philadelphia, PA 19104-6021. (peter.reese@uphs.upenn.edu).

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.