Background: HCV-infected ESRD patients derive a significant survival benefit from kidney transplantation (KT) over remaining on dialysis. Given the high mortality rates on dialysis and the unique ability to accept HCV+ and HCV- donors, understanding access to KT is essential.

Methods: 3,963 adult kidney-only candidates reported as willing to accept an HCV+ kidney (2008-2015) were identified from SRTR and defined as HCV+. Time-at-risk began at date of listing. Cumulative incidence of transplant and waitlist mortality were assessed using competing risks, and separate mixed effects Cox proportional hazards models were used to examine rates of waitlist mortality and transplantation. All models were adjusted for candidate demographic and clinical characteristics and included a random effect for listing OPO with nested listing center.

Results: HCV+ candidates were commonly older (50+: 82.6%), African-American (52.8%), and male (73.6%). Five years after listing 37.8% of candidates were transplanted with an HCV+ donor, 12.1% transplanted with an HCV- donor, and 23.6% died on the waitlist. Overall transplant rates exceeded waitlist mortality rates (22.69 vs. 11.45 per 100 PY), largely driven by transplantation with HCV+ donors (HCV+ donor: 17.72 vs. 4.97 per 100 PY). Conclusions: Among HCV+ waitlist candidates, rate of KT was highest with utilization of HCV+ donors, and importantly, these candidates were more likely to die waiting for KT than to achieve HCV-KT. In light of highly effective HCV therapies, it may be prudent to institute strategies to decrease waiting time and waitlist mortality for HCV+ candidates by increasing utilization of HCV+ donor kidneys.

CITATION INFORMATION: Shelton B, Sawinski D, Mehta S, Reed R, MacLennan P, Locke J. HCV+ Waitlist Candidates More Likely to Die Waiting for Kidney Transplant from HCV- Donor. Am J Transplant. 2017;17 (suppl 3).

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