*Purpose: The United States opioid use epidemic over the past decade has coincided with an increase in hepatitis C positive (HCV+) kidney donors. Our aim was to evaluate short-term outcomes in HCV- recipients receiving HCV NAT+ deceased donor kidneys versus HCV- kidneys.

*Methods: Adult HCV- patients receiving HCV NAT+ kidneys were matched to an HCV- recipient/donor cohort that was compatible on transplant period (± 10 months) and several SRTR Risk Adjustment Model characteristics (recipient age, gender, race) for survival after deceased donor kidney transplant. The HCV- matching donor pool excluded those who received previous or blood type A2 to B transplants. Outcomes were short-term (within 90 days) adverse events including delayed graft function, readmission, rejection, infection, and longitudinal graft function. Data were analyzed using summary statistics, t- and chi-square tests for between-group comparisons, and longitudinal mixed effects models.

*Results: The sample included 56 HCV- recipients (28 HCV NAT+, 28 HCV- donors; recipient age 57 ± 11 years; 50% males; 55% white, 32% black) transplanted between August 2018 and June 2019. Pre-transplant between-group characteristics did not differ for race, primary diagnosis, co-morbidities, surgical complication, whether dialyzed, KDPI, or for induction immunosuppression and pre-transplant patient-reported health-related QOL (all p≥ 0.177). HCV NAT+ donor recipients had significantly lower calculated panel reactive antibody values (11±21 vs 29±34, p=0.022) and statistically comparable, but clinically shorter wait times (29±23 vs 41±31 months, p=0.110). Patients on dialysis who opted for an HCV NAT+ kidney spent significantly shorter time on dialysis (48±21 vs 74±37 months, p=0.005). There was no effect of HCV NAT+ donor to HCV- recipient transplantation on delayed graft function (p=0.075), longitudinal renal function, or readmissions (p=1.00). Among patients who were readmitted within 90 days, total length of stay to date for all readmissions within 30 days averaged 3±5 vs 2±2 (p=0.465) and 9±7 vs 5±6 (p=0.122) for HCV NAT+ and HCV- donor recipients, respectively. HCV NAT+ donor recipients experienced a decrease in HCV RNA titers with DAA therapy.

*Conclusions: Our research demonstrates that use of HCV NAT+ donor kidneys in uninfected recipients is a potential avenue to increase rates of kidney transplantation without significant adverse outcomes in the early postoperative period. Visual inspection of longitudinal HCV titers indicates that HCV- recipients who acquire HCV can be successfully treated. Future studies should examine longer term outcomes and HCV infection characteristics including response to therapy over time in this recipient population.

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