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Original ArticlesTransplantation
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Trends in Discard of Kidneys from Hepatitis C Viremic Donors in the United States

Su-Hsin Chang, Massini Merzkani, Krista L. Lentine, Mei Wang, David A. Axelrod, Siddiq Anwar, Mark A. Schnitzler, Jason Wellen, William C. Chapman and Tarek Alhamad
CJASN February 2021, 16 (2) 251-261; DOI: https://doi.org/10.2215/CJN.10960720
Su-Hsin Chang
1Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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Massini Merzkani
2Division of Nephrology, Washington University School of Medicine, St. Louis, Missouri
3Transplant Epidemiology Research Collaboration, Institute of Public Health, Washington University School of Medicine, St. Louis, Missouri
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Krista L. Lentine
4Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, Missouri
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Mei Wang
1Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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David A. Axelrod
5Department of Surgery, University of Iowa, Iowa City, Iowa
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Siddiq Anwar
6Division of Nephrology, Seha Kidney Care, Abu Dhabi, United Arab Emirates
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Mark A. Schnitzler
4Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, Missouri
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Jason Wellen
7Department of Surgery, Washington University in St. Louis, St. Louis, Missouri
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William C. Chapman
7Department of Surgery, Washington University in St. Louis, St. Louis, Missouri
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Tarek Alhamad
2Division of Nephrology, Washington University School of Medicine, St. Louis, Missouri
3Transplant Epidemiology Research Collaboration, Institute of Public Health, Washington University School of Medicine, St. Louis, Missouri
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Abstract

Background and objectives Kidneys from hepatitis C virus (HCV) viremic donors have become more commonly accepted for transplant, especially after effective direct-acting antiviral therapy became available in 2014. We examined the contemporary trend of kidney discard from donors with HCV seropositivity and viremia.

Design, setting, participants, & measurements Data from the Organ Procurement and Transplantation Network were used to identify deceased donor kidneys recovered for transplant. The exposure was donor HCV antibody status in the first analyses, and donor HCV antibody and viremia status in the second analyses. Multilevel, multivariable logistic regression was used to assess the association of these HCV exposure measures with kidney discard, adjusted for donor characteristics. Multilevel analyses were conducted to account for similar kidney discard pattern within clusters of organ procurement organizations and regions.

Results Among 225,479 kidneys recovered from 2005 to 2019, 5% were from HCV seropositive donors. Compared with HCV seronegative kidneys, the odds of HCV seropositive kidney discard gradually declined, from a multivariable-adjusted odds ratio (aOR) of 7.06 (95% confidence interval [95% CI], 5.65 to 8.81) in 2014, to 1.20 (95% CI, 1.02 to 1.42) in 2019. Among 82,090 kidneys with nucleic acid amplification test results in 2015–2019, 4% were from HCV viremic donors and 2% were from aviremic seropositive donors. Compared with HCV aviremic seronegative kidneys, the odds of HCV viremic kidney discard decreased from an aOR of 4.89 (95% CI, 4.03 to 5.92) in 2018, to 1.48 (95% CI, 1.22 to 1.81) in 2019. By 2018 and 2019, aviremic seropositive status was not associated with higher odds of discard (2018: aOR, 1.13; 95% CI, 0.88 to 1.45; and 2019: aOR, 0.97; 95% CI, 0.76 to 1.23).

Conclusions Despite the decrease in kidney discard in recent years, kidneys from viremic (compared with aviremic seronegative) donors still had 48% higher odds of discard in 2019. The potential of these discarded organs to provide successful transplantation should be explored.

  • Hepatitis C virus
  • kidney discard
  • nucleic acid amplification testing
  • deceased donor
  • Received July 6, 2020.
  • Accepted November 17, 2020.
  • Copyright © 2021 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 16 (2)
Clinical Journal of the American Society of Nephrology
Vol. 16, Issue 2
February 08, 2021
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Trends in Discard of Kidneys from Hepatitis C Viremic Donors in the United States
Su-Hsin Chang, Massini Merzkani, Krista L. Lentine, Mei Wang, David A. Axelrod, Siddiq Anwar, Mark A. Schnitzler, Jason Wellen, William C. Chapman, Tarek Alhamad
CJASN Feb 2021, 16 (2) 251-261; DOI: 10.2215/CJN.10960720

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Trends in Discard of Kidneys from Hepatitis C Viremic Donors in the United States
Su-Hsin Chang, Massini Merzkani, Krista L. Lentine, Mei Wang, David A. Axelrod, Siddiq Anwar, Mark A. Schnitzler, Jason Wellen, William C. Chapman, Tarek Alhamad
CJASN Feb 2021, 16 (2) 251-261; DOI: 10.2215/CJN.10960720
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