Long-term outcomes and transmission rates in hepatitis C virus-positive donor to hepatitis C virus-negative kidney transplant recipients: Analysis of United States national data

The use of kidneys from hepatitis C virus (HCV)-positive (D+) deceased donors for HCV-negative recipients (R−) might increase the donor pool. We analyzed the national Organ Procurement and Transplant Network (OPTN) registry from 1994 to 2014 to compare the outcomes of HCV D+/R− (n = 421) to propensity-matched HCV-negative donor (D−)/R− kidney transplants, as well as with waitlisted patients who never received a transplant, in a 1:5 ratio (n = 2105, per matched group). Both 5-year graft survival (44% vs 66%; P <.001) and patient survival (57% vs 79%; P <.001) were inferior for D+/R− group compared to D−/R−. Nevertheless, 5-year patient survival from the time of wait listing was superior for D+/R− when compared to waitlisted controls (68% vs 43%; P <.001). Of the 126 D+/R− with available post-transplant HCV testing, HCV seroconversion was confirmed in 62 (49%), likely donor-derived. Five-year outcomes were similar between D+/R− that seroconverted vs D+/R− that did not (n = 64). Our analysis shows inferior outcomes for D+/R− patients although detailed data on pretransplant risk factors was not available. Limited data suggest that HCV transmission occurred in half of HCV D+/R− patients, although this might not have been the primary factor contributing to the poor observed outcomes.