*Purpose: The utilization of Hepatitis C viremic (HCV+) deceased donor kidneys for uninfected recipients allows for increased opportunities for organ transplantation. Initial studies have indicated similar short-term graft outcomes in comparison to recipients of hepatitis C negative (HCV-) donors. Our aim was to understand longer term outcomes by assessing rejection-free survival, graft function, and patient and graft survival of HCV+ donor to HCV- recipient kidney transplants over the first posttransplant year.

*Methods: This was a retrospective single-center study of deceased donor kidney transplant (DDKT) recipients of HCV+ kidneys (cases) who were matched 1:1 to recipients of HCV- kidneys (controls) by age, gender, race, history of diabetes, kidney donor profile index (KDPI) and calculated panel reactive antibody (cPRA). Data were analyzed using summary statistics, analysis of variance, chi-square tests, Kaplan-Meier survival methods, and multivariable mixed effects models of longitudinal serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) data.

*Results: The sample included 65 cases and 65 controls who had statistically comparable demographic and clinical characteristics. Mean age of recipients was 55±11 years, mean KDPI 25±17%, mean cPRA 16±30%, 69% male, 57% white, 95% hypertensive, and 45% diabetic. The majority of patients received alemtuzumab for induction (91%). All were maintained on calcineurin inhibitor and mycophenolate mofetil for maintenance immunosuppression, with 58% controls and 9% cases on steroid-sparing regimens. Among cases, 64 of 65 (98%) achieved a sustained virologic response at 12 weeks posttreatment with a first course of direct acting antivirals. There was no significant difference between cases and controls over the first posttransplant year in terms of patient survival (p=0.093), death-censored graft survival (p= 0.141), or rejection-free graft survival (p=0.164). After adjusting for delayed graft function (p<0.05), overall SCr showed a statistically marginal increase (p=0.045) and eGFR was statistically stable (p=0.464) between posttransplant day 31 and month 12, and there were no between-group differences in the temporal trajectories (time by group interaction p>0.292) or the overall values of SCr or eGFR (p>0.346). At approximately 12 months posttransplant, mean eGFR was 58.6±17.3 and 56.3±2.1 (p =0.470) and mean SCr was 1.29±0.57 and 1.34±0.64 (p=0.662) for cases and controls, respectively.

*Conclusions: Aviremic recipients of HCV+ kidneys had comparable rejection-free survival, graft function and graft survival at 12 months posttransplant compared to HCV- matched controls.

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