The introduction of interferon-free direct-acting antivirals(DAAs) in December 2013 dramatically improved outcomes for individuals with Hepatitis C. The impacts of these therapies on utilization and outcomes associated with HCV+ deceased-donor (DD) kidneys for HCV+ recipients have not been previously characterized.

METHODS: Using 2005-2015 SRTR data, we studied 6,904 HCV+ adult KT recipients, using modified Poisson regression to estimate the relative rate(RR) of receiving an HCV+ DDKT, and Cox regression to estimate post-transplant patient and graft survival associated with receiving a HCV+ DDKT, adjusting for recipient and donor characteristics.

RESULTS: The proportion of HCV+ recipients who received a HCV+ DDKT increased from 31% in early 2013 to 42% in 2015. HCV+ recipients were 30% more likely to receive a HCV+ kidney after December 2013[aRR _1.181.30_1.44, p<0.001]. This increase in utilization was in excess of any existing trends prior to December 2013(p-interaction=0.007). HCV+ kidneys were discarded at 3.6 times the rate of HCV- kidneys (52% versus 16%) before and after Dec. 2013[aRR _3.343.59_3.86,p<0.001, p-interaction=0.5]. Risk of patient death associated with receiving a HCV+ versus HCV- DDKT varied with time, with 33% reduced risk in the first year[aHR_0.510.67_0.88,p=0.004] and two-fold higher risk 3 years post-DDKT[aHR_1.552.14_2.95,p<0.001].

CONCLUSION: The utilization of HCV+ kidneys has increased since the introduction of highly effective HCV therapies. HCV+ kidneys continue to be discarded at almost four times the rate of comparable HCV- kidneys. Risk of death is lower among recipients of HCV+ versus HCV- kidneys within the first year, yet risk increases over time. Changes in post-transplant outcomes under DAAs remain unknown, as we are limited by data in the recent drug era.

CITATION INFORMATION: Bowring M, Kucirka L, Massie A, Luo X, Sulkowski M, Segev D, Durand C. Utilization and Post-Transplant Outcomes Associated with Hepatitis C+ Donor Kidneys in the Advent of Direct-Acting Antivirals. Am J Transplant. 2016;16 (suppl 3).

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