Survey of Clinician Opinions on Use of Organ Transplants from Hepatitis C Virus Positive Donors: Identifying & Overcoming Barriers
1Saint Louis U, Saint Louis, MO, 2Washington U, Saint Louis, MO, 3Northwestern, Chicago, IL, 4Vanderbilt, Nashville, TN, 5Georgetown, Washington, DC, 6U Penn, Philadelphia, MO, 7UAB, Birmingham, AL, 8U Iowa, Iowa City, IA
Meeting: 2020 American Transplant Congress
Abstract number: 280
Keywords: Donors, marginal, Graft acceptance, Hepatitis C, Kidney transplantation
Session Information
Session Name: All Organs: Viral Hepatitis
Session Type: Oral Abstract Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:45pm
Presentation Time: 3:39pm-3:51pm
Location: Virtual
*Purpose: Increasing the use of Hepatitis C Virus (HCV) viremic (Nucleic Acid Testing (NAT)+) donor organs for HCV uninfected (HCV-) patients is a potential approach to address the organ shortage. We surveyed U.S. kidney transplant (KTx) programs regarding current practices, barriers and concerns related to this emerging transplant strategy.
*Methods: A survey was designed and distributed to U.S. KTx program staff in Fall 2019 using the Qualtrics system and professional list servs.
*Results: Participants represented 75 KTx programs, from all 11 OPTN regions. Most survey respondents were transplant nephrologists (45%) or surgeons (40%). Acceptance of HCV Ab+/NAT+ donors was more common for HCV+ recipients (69% programs) compared to HCV- recipients (65% programs) (Fig A). Of those who use HCV Ab+/NAT+ organs for HCV- recipients, 50% accept these donors under a clinical protocol, 26% do so under a study or trial protocol, and 24% do so as standard of care (SOC). Significantly higher proportions of clinicians in OPTN regions 2 (82%), 8 (75%), 9 (100%), 10 (83%), and 11 (75%) accept HCV Ab+/NAT+ donors for HCV- recipients (p=0.02). Of the 42 centers that accept HCV Ab+/NAT+ donors for HCV- recipients, the largest proportion (24%) report testing for HCV at day 0, post-transplant day 1, and at treatment weeks 1, 2, 3, 4, 8, and 12, followed by continuing testing at weeks 2, 4, 8, and 12 after treatment. Another 17% follow the same practice, but without post-treatment testing. Most centers (67%) start direct acting antiviral agent (DAA) therapy after discharge, but only with documentation of HCV viremia in the recipient. For patients’ whose insurance declines to cover DAA therapy, 71% of centers provide a complete course of medication through the transplant hospital. In addition to reporting variation in practice, clinicians endorse multiple concerns related to use of HCV Ab+/NAT+ donors for HCV- recipients. (Fig B).
*Conclusions: A national survey of 75 KTx programs demonstrates that more than half accept organs from HCV viremic donors for HCV- recipients, resonating with encouraging results in recent studies. However, practice varies significantly between centers, and between OPTN regions. Future research should determine best clinical practices to inform national standardization.
To cite this abstract in AMA style:
Lentine K, Alhamad T, Peipert D, Caliskan Y, Concepcion B, Forbes R, Schnitzler M, Zhang Z, Chang S, Cooper M, Bloom R, Mannon R, Axelrod D. Survey of Clinician Opinions on Use of Organ Transplants from Hepatitis C Virus Positive Donors: Identifying & Overcoming Barriers [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/survey-of-clinician-opinions-on-use-of-organ-transplants-from-hepatitis-c-virus-positive-donors-identifying-overcoming-barriers/. Accessed November 22, 2024.« Back to 2020 American Transplant Congress