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Impact of Willingness to Accept Hepatitis C Seropositive Kidneys Among Hepatitis C RNA-Positive Waitlisted Patients

Sageshima, Junichiro, MD1; Troppmann, Christoph, MD1; McVicar, John P., MD1; Santhanakrishnan, Chandrasekar, MD, MPH1; de Mattos, Angelo M., MD, MPH2; Perez, Richard V., MD1

doi: 10.1097/TP.0000000000002096
Original Clinical Science—General

Background Kidney transplantation from hepatitis C seropositive (HCV+) donors may benefit hepatitis C RNA-positive (RNA+) candidates, but it is unclear how the willingness to be listed for and accept such kidneys affects waitlist and transplant outcomes.

Methods In a single-center retrospective analysis, HCV+ transplant candidates (N = 169) listed from March 2004 to February 2015 were evaluated. All RNA+ candidates were offered the option to be listed for HCV+ donors. RNA− candidates were listed only for HCV− donors.

Results Fifty-seven patients (51% of all RNA+ transplant candidates) willing to accept HCV+ donors were listed for both HCV+ and HCV− donor kidneys. During 6-year follow up, 43 (75%) of 57 patients accepting HCV+ versus 19 (35%) of 55 patients not accepting HCV+ received a deceased donor kidney transplant (P < 0.0001). Multivariable analysis demonstrated that willingness to be listed for and accept HCV+ kidneys was associated with receiving deceased donor kidney transplant (P = 0.0016). Fewer patients accepting HCV+ donors (7 [12%] vs 16 [29%]) were removed from the list due to death or deteriorated medical condition (P = 0.0117). Posttransplant patient and graft survival rates were not significantly different. Overall patient survival since the listing (combined waitlist and posttransplant survival) was similar among the groups.

Conclusions HCV RNA+ candidates had better access to transplantation and similar overall survival before the era of widespread use of direct-acting anti-HCV agents.

This single-center retrospective analysis in HCV+ patients suggests that willingness to accept kidney allografts from HCV + donors was associated with increased rate of transplantation, lower removal from the list and transplant outcomes comparable to those listed only for HCV- donors.

1 Department of Surgery, University of California Davis, Sacramento, CA.

2 Department of Internal Medicine, University of California Davis, Sacramento, CA.

Received 13 September 2017. Revision received 14 November 2017.

Accepted 28 November 2017.

The authors declare no funding or conflicts of interest.

J.S. participated in research design, data collection and analysis, interpretation of the data, and drafting the work. C.T. participated in the interpretation of data, drafting the work, and critical revision. J.P.M.V. participated in the interpretation of the data and critical revision. C.S. participated in interpretation of the data and critical revision. A.M.d.M. participated in data collection and analysis, interpretation of the data and critical revision. R.V.P. participated in research design, interpretation of the data and critical revision.

Correspondence: Junichiro Sageshima, MD, University of California Davis Medical Center, 2315 Stockton Boulevard HSF 2011, Sacramento, CA 95817. (jsageshima@ucdavis.edu).

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