National Trends in Utilization and 1-Year Outcomes with Transplantation of HCV-Viremic Kidneys

Vishnu S. Potluri, David S. Goldberg, Sumit Mohan, Roy D. Bloom, Deirdre Sawinski, Peter L. Abt, Emily A. Blumberg, Chirag R. Parikh, James Sharpe, K. Rajender Reddy, M. Molnár, Meghan Sise, Peter P. Reese

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND: Recent pilot trials have demonstrated the safety of transplanting HCV-viremic kidneys into HCV-seronegative recipients. However, it remains unclear if allograft function is impacted by donor HCV-viremia or recipient HCV-serostatus. METHODS: We used national United States registry data to examine trends in HCV-viremic kidney use between 4/1/2015 and 3/31/2019. We applied advanced matching methods to compare eGFR for similar kidneys transplanted into highly similar recipients of kidney transplants. RESULTS: Over time, HCV-seronegative recipients received a rising proportion of HCV-viremic kidneys. During the first quarter of 2019, 200 HCV-viremic kidneys were transplanted into HCV-seronegative recipients, versus 69 into HCV-seropositive recipients, while 105 HCV-viremic kidneys were discarded. The probability of HCV-viremic kidney discard has declined over time. Kidney transplant candidates willing to accept a HCV-seropositive kidney increased from 2936 to 16,809 from during this time period. When transplanted into HCV-seronegative recipients, HCV-viremic kidneys matched to HCV-non-viremic kidneys on predictors of organ quality, except HCV, had similar 1-year eGFR (66.3 versus 67.1 ml/min per 1.73 m2, P=0.86). This was despite the much worse kidney donor profile index scores assigned to the HCV-viremic kidneys. Recipient HCV-serostatus was not associated with a clinically meaningful difference in 1-year eGFR (66.5 versus 71.1 ml/min per 1.73 m2, P=0.056) after transplantation of HCV-viremic kidneys. CONCLUSIONS: By 2019, HCV-seronegative patients received the majority of kidneys transplanted from HCV-viremic donors. Widely used organ quality scores underestimated the quality of HCV-viremic kidneys based on 1-year allograft function. Recipient HCV-serostatus was also not associated with worse short-term allograft function using HCV-viremic kidneys.

Original languageEnglish
Pages (from-to)1939-1951
Number of pages13
JournalJournal of the American Society of Nephrology : JASN
Volume30
Issue number10
DOIs
Publication statusPublished - Oct 1 2019

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Transplantation
Kidney
Allografts
Tissue Donors
Viremia
Registries

Keywords

  • end stage kidney disease
  • hepatitis
  • kidney transplantation
  • transplantation

ASJC Scopus subject areas

  • Nephrology

Cite this

Potluri, V. S., Goldberg, D. S., Mohan, S., Bloom, R. D., Sawinski, D., Abt, P. L., ... Reese, P. P. (2019). National Trends in Utilization and 1-Year Outcomes with Transplantation of HCV-Viremic Kidneys. Journal of the American Society of Nephrology : JASN, 30(10), 1939-1951. https://doi.org/10.1681/ASN.2019050462

National Trends in Utilization and 1-Year Outcomes with Transplantation of HCV-Viremic Kidneys. / Potluri, Vishnu S.; Goldberg, David S.; Mohan, Sumit; Bloom, Roy D.; Sawinski, Deirdre; Abt, Peter L.; Blumberg, Emily A.; Parikh, Chirag R.; Sharpe, James; Reddy, K. Rajender; Molnár, M.; Sise, Meghan; Reese, Peter P.

In: Journal of the American Society of Nephrology : JASN, Vol. 30, No. 10, 01.10.2019, p. 1939-1951.

Research output: Contribution to journalArticle

Potluri, VS, Goldberg, DS, Mohan, S, Bloom, RD, Sawinski, D, Abt, PL, Blumberg, EA, Parikh, CR, Sharpe, J, Reddy, KR, Molnár, M, Sise, M & Reese, PP 2019, 'National Trends in Utilization and 1-Year Outcomes with Transplantation of HCV-Viremic Kidneys', Journal of the American Society of Nephrology : JASN, vol. 30, no. 10, pp. 1939-1951. https://doi.org/10.1681/ASN.2019050462
Potluri, Vishnu S. ; Goldberg, David S. ; Mohan, Sumit ; Bloom, Roy D. ; Sawinski, Deirdre ; Abt, Peter L. ; Blumberg, Emily A. ; Parikh, Chirag R. ; Sharpe, James ; Reddy, K. Rajender ; Molnár, M. ; Sise, Meghan ; Reese, Peter P. / National Trends in Utilization and 1-Year Outcomes with Transplantation of HCV-Viremic Kidneys. In: Journal of the American Society of Nephrology : JASN. 2019 ; Vol. 30, No. 10. pp. 1939-1951.
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abstract = "BACKGROUND: Recent pilot trials have demonstrated the safety of transplanting HCV-viremic kidneys into HCV-seronegative recipients. However, it remains unclear if allograft function is impacted by donor HCV-viremia or recipient HCV-serostatus. METHODS: We used national United States registry data to examine trends in HCV-viremic kidney use between 4/1/2015 and 3/31/2019. We applied advanced matching methods to compare eGFR for similar kidneys transplanted into highly similar recipients of kidney transplants. RESULTS: Over time, HCV-seronegative recipients received a rising proportion of HCV-viremic kidneys. During the first quarter of 2019, 200 HCV-viremic kidneys were transplanted into HCV-seronegative recipients, versus 69 into HCV-seropositive recipients, while 105 HCV-viremic kidneys were discarded. The probability of HCV-viremic kidney discard has declined over time. Kidney transplant candidates willing to accept a HCV-seropositive kidney increased from 2936 to 16,809 from during this time period. When transplanted into HCV-seronegative recipients, HCV-viremic kidneys matched to HCV-non-viremic kidneys on predictors of organ quality, except HCV, had similar 1-year eGFR (66.3 versus 67.1 ml/min per 1.73 m2, P=0.86). This was despite the much worse kidney donor profile index scores assigned to the HCV-viremic kidneys. Recipient HCV-serostatus was not associated with a clinically meaningful difference in 1-year eGFR (66.5 versus 71.1 ml/min per 1.73 m2, P=0.056) after transplantation of HCV-viremic kidneys. CONCLUSIONS: By 2019, HCV-seronegative patients received the majority of kidneys transplanted from HCV-viremic donors. Widely used organ quality scores underestimated the quality of HCV-viremic kidneys based on 1-year allograft function. Recipient HCV-serostatus was also not associated with worse short-term allograft function using HCV-viremic kidneys.",
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AU - Sawinski, Deirdre

AU - Abt, Peter L.

AU - Blumberg, Emily A.

AU - Parikh, Chirag R.

AU - Sharpe, James

AU - Reddy, K. Rajender

AU - Molnár, M.

AU - Sise, Meghan

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N2 - BACKGROUND: Recent pilot trials have demonstrated the safety of transplanting HCV-viremic kidneys into HCV-seronegative recipients. However, it remains unclear if allograft function is impacted by donor HCV-viremia or recipient HCV-serostatus. METHODS: We used national United States registry data to examine trends in HCV-viremic kidney use between 4/1/2015 and 3/31/2019. We applied advanced matching methods to compare eGFR for similar kidneys transplanted into highly similar recipients of kidney transplants. RESULTS: Over time, HCV-seronegative recipients received a rising proportion of HCV-viremic kidneys. During the first quarter of 2019, 200 HCV-viremic kidneys were transplanted into HCV-seronegative recipients, versus 69 into HCV-seropositive recipients, while 105 HCV-viremic kidneys were discarded. The probability of HCV-viremic kidney discard has declined over time. Kidney transplant candidates willing to accept a HCV-seropositive kidney increased from 2936 to 16,809 from during this time period. When transplanted into HCV-seronegative recipients, HCV-viremic kidneys matched to HCV-non-viremic kidneys on predictors of organ quality, except HCV, had similar 1-year eGFR (66.3 versus 67.1 ml/min per 1.73 m2, P=0.86). This was despite the much worse kidney donor profile index scores assigned to the HCV-viremic kidneys. Recipient HCV-serostatus was not associated with a clinically meaningful difference in 1-year eGFR (66.5 versus 71.1 ml/min per 1.73 m2, P=0.056) after transplantation of HCV-viremic kidneys. CONCLUSIONS: By 2019, HCV-seronegative patients received the majority of kidneys transplanted from HCV-viremic donors. Widely used organ quality scores underestimated the quality of HCV-viremic kidneys based on 1-year allograft function. Recipient HCV-serostatus was also not associated with worse short-term allograft function using HCV-viremic kidneys.

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KW - end stage kidney disease

KW - hepatitis

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