Is Donor Hepatitis C Virus Infection Status Associated with Early Post-Kidney Transplant Failure in the Era of Direct-Acting Antiviral Medications?

S. Sutcliffe¹, S. Chang¹, D. Stewart², M. Ji³, K. Lentine⁴, G. Gupta⁵, T. Alhamad⁶

¹Washington University School of Medicine, Saint Louis, MO, ²United Network for Organ Sharing, Richmond, VA, ³Washington University in St. Louis School of Medicine, Saint Louis, MO, ⁴Saint Louis University School of Medicine, Saint Louis, MO, ⁵Virginia Commonwealth University School of Medicine, Richmond, VA, ⁶Washington University School of Medicine at St. Louis, Saint Louis, MO

Meeting: 2022 American Transplant Congress

Abstract number: 201

Keywords: Graft failure, Hepatitis C, Kidney transplantation

Topic: Clinical Science » Kidney » 32 - Kidney Deceased Donor Selection

Session Information

Session Name: Kidney Deceased Donor Selection I

Session Type: Rapid Fire Oral Abstract

Date: Monday, June 6, 2022

Session Time: 3:30pm-5:00pm

Presentation Time: 4:00pm-4:10pm

Location: Hynes Ballroom C

*Purpose: To determine the influence of donor hepatitis C virus (HCV) infection status on early kidney transplant (KT) failure in HCV negative recipients in the modern era of highly-effective, direct-acting antiviral medications.

*Methods: HCV-negative patients greater or equal to 18 years of age in the Organ Procurement and Transplantation Network database who received their first KT from a deceased donor between 2/28/2018 (when recipient HCV nucleic acid amplification testing [NAT] data became available) and 7/6/2021 were included. Cox proportional hazards regression was used to estimate hazards ratios (HRs) for graft failure by donor HCV status (antibody [Ab]-/NAT-, Ab+/NAT-, and NAT+), adjusting for multiple transplant, donor, and recipient characteristics. Recipient characteristics were addressed by including a propensity score predicting patient selection to receive an NAT+ or Ab+/NAT- kidney in the model.

*Results: Of the 41,942 included patients, 1,689 received an HCV Ab+/NAT- kidney and 2,331 received a NAT+ kidney. 2,752 patients experienced KT failure over a median of 364 days of follow-up. Compared to donor HCV Ab-/NAT- status, Ab+/NAT- (HR=0.83, 95% CI: 0.66-1.03) and NAT+ (HR=0.86, 95% CI: 0.70-1.05) status were both associated with non-significantly lower risks of KT failure.

*Conclusions: Our findings suggest that transplanting HCV+ donor kidneys into HCV- recipients is not associated with an elevated risk of early graft failure in the modern era of direct-acting antiviral medications. They also suggest that inclusion of donor HCV status in the Kidney Donor Risk Index may no longer be appropriate; however, further research on longer-term outcomes beyond 0-3 years is needed before firm conclusions can be made.

To cite this abstract in AMA style:

Sutcliffe S, Chang S, Stewart D, Ji M, Lentine K, Gupta G, Alhamad T. Is Donor Hepatitis C Virus Infection Status Associated with Early Post-Kidney Transplant Failure in the Era of Direct-Acting Antiviral Medications? [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/is-donor-hepatitis-c-virus-infection-status-associated-with-early-post-kidney-transplant-failure-in-the-era-of-direct-acting-antiviral-medications/. Accessed May 9, 2025.

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