Background: Kidney transplantation (KTxp)with HCV kidneys (HCV D+)may represent a safe resource to expand the donor pool, and to reduce waiting time in patients with (HCV R+)or without HCV infection (HCV R-).There is good evidence to support that HCV D+/R+ kidney transplant is safe and results in shorter wait times without affecting graft or patient survivals when compared with patients who receive HCV D-/R+ kidney transplants. However it is unknown whether patients without HCV infection who receive HCV+ kidneys (HCV D+/R-)can derive same benefits.This issue is becoming increasingly relevant due to the advent of safe and efficacious direct-acting antiviral therapy.

Methods: Using the Organ Procurement and Transplant Network (OPTN) database, D+/R- transplants were compared to D-/R- recipients for all adult kidney-only transplants performed between 2002-2012. Since it is likely that the sickest patients received HCV D+/R- kidneys we used propensity score analysis. To estimate the propensity score for group assignment in recipients we considered: age, diabetes, re-graft and dialysis duration, and in donors: age, height, weight, race, hypertension, diabetes status, cause of death, serum creatinine, HCV status, and DCD status. We used the inverse probability of treatment/group weighting method using the propensity score. A weight was assigned to each subject as the inverse probability of being in either D+/R-, or D-/R- group, depending on their original assignment. Primary outcomes were 5-year graft and recipient survivals.

Results: 692 D+/R- and 172458 D-/R- kidney-only transplants were performed in the study period. After estimation of group weight using the propensity score and elimination of patients with missing data, a total of 582 D+/R-and 154263 D-/R-transplants were analyzed. There was a significant difference in patient survival probability between the two groups (D+/R-: 0.59 vs D-/R-: 0.84; p<0.0001). Similarly there was significant difference in graft survival between the two groups (D+/R-: 0.45 vs D-/R-: 0.81; p<0.0001) using the weighted log-rank test statistics. Conclusion: This study shows inferior results for D+/R- kidney transplants compared to D-/R- after accounting for various factors that can affect donor and recipient quality. Further studies are needed to evaluate the use of D+ kidneys to R- in the context of modern anti-viral therapy.

CITATION INFORMATION: Fattah H, Kang L, Dave H, Kumar D, King A, Bhati C, Sharma A, Gupta G. Inferior Outcomes in Hepatitis C Virus Positive Donors to Hepatitis C Virus Negative Kidney Recipients: Analysis of National Data. Am J Transplant. 2016;16 (suppl 3).

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