TY - JOUR
T1 - Changes in Utilization and Discard of HCV Antibody-Positive Deceased Donor Kidneys in the Era of Direct-Acting Antiviral Therapy
AU - Bowring, Mary G.
AU - Kucirka, Lauren M.
AU - Massie, Allan B.
AU - Ishaque, Tanveen
AU - Bae, Sunjae
AU - Shaffer, Ashton A.
AU - Wang, Jacqueline Garonzik
AU - Sulkowski, Mark
AU - Desai, Niraj
AU - Segev, Dorry L.
AU - Durand, Christine M.
N1 - Funding Information:
C.M.D. is supported by grant K23CA177321-01A1 from the National Cancer Institute. M.S. is supported by National Institute of Allergy and Infectious Disease by grant K24DA034621. D.L.S, L.M.K., A.A.S., and A.B.M. are supported by the National Institute of Diabetes and Digestive and Kidney Diseases by grants K24DK101828 (Segev), F30DK095545 (Kucirka), F30DK116658 (Shaffer) and K23DK101677 (Massie), respectively.
Funding Information:
C.M.D. also received funds from Gilead for grant review. M.S. served as scientific advisor for AbbVie, Gilead Sciences, Cocrystal, Janssen, Merck Pharmaceuticals, and Trek. M.S. also received research grants from AbbVie, Gilead Sciences, and Merck Pharmaceuticals. The remaining authors declare no conflicts of interest.
Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Background: The availability of direct-acting antiviral (DAA) therapy might have impacted use of hepatitis C virus (HCV)-infected (HCV+) deceased donor kidneys for transplantation. Methods: We used 2005 to 2018 Scientific Registry of Transplant Recipients data to identify 18 936 candidates willing to accept HCV+ kidneys and 3348 HCV+ recipients of HCV+ kidneys. We compared willingness to accept, utilization, discard, and posttransplant outcomes associated with HCV+ kidneys between 2 treatment eras (interferon [IFN] era, January 1, 2005 to December 5, 2013 vs DAA era, December 6, 2013 to August 2, 2018). Models were adjusted for candidate, recipient, and donor factors where appropriate. Results: In the DAA era, candidates were 2.2 times more likely to list as willing to accept HCV+ kidneys (adjusted odds ratio, 2.072.232.41; P < 0.001), and HCV+ recipients were 1.95 times more likely to have received an HCV+ kidney (adjusted odds ratio, 1.761.952.16; P < 0.001). Median Kidney Donor Profile Index of HCV+ kidneys decreased from 77 (interquartile range [IQR], 59-90) in 2005 to 53 (IQR, 40-67) in 2017. Kidney Donor Profile Index of HCV- kidneys remained unchanged from 45 (IQR, 21-74) to 47 (IQR, 24-73). After adjustment, HCV+ kidneys were 3.7 times more likely to be discarded than HCV- kidneys in the DAA era (adjusted relative rate, 3.363.674.02; P < 0.001); an increase from the IFN era (adjusted relative rate, 2.783.023.27; P < 0.001). HCV+ kidney use was concentrated within a subset of centers; 22.5% of centers performed 75% of all HCV+ kidney transplants in the DAA era. Mortality risk associated with HCV+ kidneys remained unchanged (aHR, 1.071.191.32 in both eras). Conclusions: Given the elevated risk of death on dialysis facing HCV+ candidates, improving quality of HCV+ kidneys, and DAA availability, broader utilization of HCV+ kidneys is warranted to improve access in this era of organ shortage.
AB - Background: The availability of direct-acting antiviral (DAA) therapy might have impacted use of hepatitis C virus (HCV)-infected (HCV+) deceased donor kidneys for transplantation. Methods: We used 2005 to 2018 Scientific Registry of Transplant Recipients data to identify 18 936 candidates willing to accept HCV+ kidneys and 3348 HCV+ recipients of HCV+ kidneys. We compared willingness to accept, utilization, discard, and posttransplant outcomes associated with HCV+ kidneys between 2 treatment eras (interferon [IFN] era, January 1, 2005 to December 5, 2013 vs DAA era, December 6, 2013 to August 2, 2018). Models were adjusted for candidate, recipient, and donor factors where appropriate. Results: In the DAA era, candidates were 2.2 times more likely to list as willing to accept HCV+ kidneys (adjusted odds ratio, 2.072.232.41; P < 0.001), and HCV+ recipients were 1.95 times more likely to have received an HCV+ kidney (adjusted odds ratio, 1.761.952.16; P < 0.001). Median Kidney Donor Profile Index of HCV+ kidneys decreased from 77 (interquartile range [IQR], 59-90) in 2005 to 53 (IQR, 40-67) in 2017. Kidney Donor Profile Index of HCV- kidneys remained unchanged from 45 (IQR, 21-74) to 47 (IQR, 24-73). After adjustment, HCV+ kidneys were 3.7 times more likely to be discarded than HCV- kidneys in the DAA era (adjusted relative rate, 3.363.674.02; P < 0.001); an increase from the IFN era (adjusted relative rate, 2.783.023.27; P < 0.001). HCV+ kidney use was concentrated within a subset of centers; 22.5% of centers performed 75% of all HCV+ kidney transplants in the DAA era. Mortality risk associated with HCV+ kidneys remained unchanged (aHR, 1.071.191.32 in both eras). Conclusions: Given the elevated risk of death on dialysis facing HCV+ candidates, improving quality of HCV+ kidneys, and DAA availability, broader utilization of HCV+ kidneys is warranted to improve access in this era of organ shortage.
UR - http://www.scopus.com/inward/record.url?scp=85055969396&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85055969396&partnerID=8YFLogxK
U2 - 10.1097/TP.0000000000002323
DO - 10.1097/TP.0000000000002323
M3 - Article
C2 - 29912046
AN - SCOPUS:85055969396
SN - 0041-1337
VL - 102
SP - 2088
EP - 2095
JO - Transplantation
JF - Transplantation
IS - 12
ER -