Willingness of End-Stage Renal Disease Patients (ESRD) without Hepatitis C (HCV) to Accept a HCV+ Kidney.
1UPENN, Philadelphia, PA
2Yale, New Haven, CT
Meeting: 2017 American Transplant Congress
Abstract number: A297
Keywords: Ethics, Hepatitis C, Kidney transplantation
Session Information
Session Name: Poster Session A: Viral Conundrums
Session Type: Poster Session
Date: Saturday, April 29, 2017
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall D1
Background: New HCV drugs could reduce the risks of donor-derived HCV infection. However, it is unknown if HCV-negative (HCV-) ESRD patients would accept an HCV+ kidney.
Methods: We first performed semi-structured interviews with 17 HCV- patients to assess attitudes about HCV+ organs. Next, in a conjoint study, 185 HCV- patients seeking transplant at two centers received concise education about HCV and the possibility of reducing waiting time by accepting an HCV+ kidney. Each participant made 12 decisions about whether to accept a hypothetical offer of a HCV+ transplant in which we varied expected waiting time for a HCV- offer (2 vs 5 yrs), kidney quality (60 year old donor with hypertension vs 20 yr donor) and probability of HCV cure (75%, 90% vs 95%). Participants also completed the “Trust in Physician” scale.
Results: Most interviewees had little knowledge of HCV; the most common theme was concern about viral complications. In conjoint scenarios, 29% of respondents would accept an HCV+ kidney under all scenarios, 53% would accept an HCV+ kidney only under some scenarios, and 18% refused all 12 HCV+ kidneys. For the binary outcome of refusing all HCV+ organs, black patients were more than twice as likely to refuse all offers (26% vs 12% for non-black patients, p=0.01). However, in a multivariable analysis of all 12 decisions, race and physician trust were not associated with overall decision-making; instead, participants who were older, male and prior transplant recipients were most willing to accept an HCV+ kidney. Willingness to accept an HCV+ kidney was strongly affected by cure rate and donor quality.
| OR | CI | p | |
| HCV cure 95% (vs 75%) | 2.45 | 1.95, 3.09 | <0.01 |
| HCV cure 90% (vs 75%) | 1.81 | 1.50, 2.19 | <0.01 |
| 20 year old donor (vs 60 yr) | 2.30 | 1.87, 2.82 | <0.01 |
| Wait 5 yr for HCV- kidney (vs 2 yr) | 1.43 | 1.24, 1.66 | <0.01 |
| Candidate variables | |||
| Age >60 yrs (vs <45) | 2.74 | 1.34, 5.61 | <0.01 |
| Age 46 – 60 yrs (vs <45) | 1.22 | 0.66, 2.26 | 0.52 |
| Prior transplant | 2.88 | 1.13, 7.32 | 0.03 |
| Male | 1.89 | 1.12, 3.20 | 0.02 |
Summary: Most HCV- patients would consider an HCV+ kidney transplant under certain circumstances. These findings should motivate wider usage of HCV+ kidneys.
CITATION INFORMATION: Reese P, Goldberg D, Mussell A, McCauley M, Sawinski D, Molina N, Tomlin R, Doshi S, Abt P, Blumberg E, Thiessen C, Kulkarni S, Esnaola G. Willingness of End-Stage Renal Disease Patients (ESRD) without Hepatitis C (HCV) to Accept a HCV+ Kidney. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Reese P, Goldberg D, Mussell A, McCauley M, Sawinski D, Molina N, Tomlin R, Doshi S, Abt P, Blumberg E, Thiessen C, Kulkarni S, Esnaola G. Willingness of End-Stage Renal Disease Patients (ESRD) without Hepatitis C (HCV) to Accept a HCV+ Kidney. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/willingness-of-end-stage-renal-disease-patients-esrd-without-hepatitis-c-hcv-to-accept-a-hcv-kidney/. Accessed November 22, 2024.« Back to 2017 American Transplant Congress