Introduction:
There exists a disparity between demand and supply of organs for kidney transplant, resulting in prolonged waitlist time and poor outcomes. With the advent of effective therapy in the form of direct-acting antiviral (DAA) agents for hepatis C (HCV), it is increasingly becoming popular to accept organs from HCV Nucleic Acid Amplification Test (NAAT) positive donor pool. We share our experience of kidney transplant among HCV sero-discordant donor-recipient pairs over 5 years.
Methods:
We performed a retrospective single center review of all adult deceased donor kidney transplants from HCV NAAT positive donors between January 2018 to August 2023. We collected information from medical records including donor and recipient age, kidney donor profile index (KDPI), calculated panel reactive antibody (cPRA), donor (D) and recipient (R) cytomegalovirus (CMV) status, human polyomavirus (BK), induction and maintenance immunosuppression and creatinine and urine protein creatinine ratio (UPCR).
The following outcomes were studied at 1-year and 3-year post transplant: patient and allograft survival, UPCR, CMV and BK viremia and biopsy proven acute rejection.
Results:
We report outcomes of 40 HCV uninfected recipients who received kidney from HCV NAAT positive donors, followed by treatment of HCV with DAA in the immediate post-transplant period. The mean age of recipients was 58.3 ±10.6 years. The mean age of donors was 41.4±11.2 years. Brain dead donors were 82%. Mean KDPI was 62.2±17.1. cPRA was 0 in 67.5% (25/37) recipients. Nineteen pairs were considered high risk for CMV (D+/R-). Patient survival was 95% at 1-year and 85% at 3-years. All six patients who demised had death with a functioning allograft. Allograft survival was 100% at 1-year (38/38) and 96% at 3-year (23/24). Median UPCR at baseline, 1-year and 3-year were 0.99, 0.14 and 1.1, respectively. BK viremia (>10000 IU/ml) was seen in 7% (3/38) patients within 1-year and 10% (2/20) at 3-year. CMV viremia (>1500 IU/ml) was observed in 21% (21/38) patients at 1-year and 14% (3/21) at 3-year; all of whom were high D+/R-. Two patients had doubling of creatinine at 3-year, of which one had mixed rejection, and another had transplant glomerulopathy on biopsy.
Conclusions:
Our observations suggest kidney transplant from HCV NAAT positive donors to HCV uninfected recipients results in satisfactory allograft and patient related outcomes in the short term (up to 3 years). These findings support the expansion of donor pool to include HCV infected donors, thereby optimizing organ utilization and decreasing waitlist time.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.