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Center‐level trends in utilization of HCV ‐exposed donors for HCV ‐uninfected kidney and liver transplant recipients in the United States
Author(s) -
Bowring Mary G.,
Shaffer Ashton A.,
Massie Allan B.,
Cameron Andrew,
Desai Niraj,
Sulkowski Mark,
GaronzikWang Jacqueline,
Segev Dorry L.
Publication year - 2019
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15355
Subject(s) - medicine , liver transplantation , interquartile range , transplantation , hepatitis c , hepatitis c virus , gastroenterology , kidney transplantation , nat , immunology , virus , computer network , computer science
Several single‐center reports of using HCV ‐viremic organs for HCV ‐uninfected ( HCV ‐) recipients were recently published. We sought to characterize national utilization of HCV ‐exposed donors for HCV ‐ recipients ( HCV D+/R−) in kidney transplantation ( KT ) and liver transplantation ( LT ). Using SRTR data (April 1, 2015‐December 2, 2018) and Gini coefficients, we studied center‐level clustering of 1193 HCV D+/R− KT s and LT s. HCV ‐viremic ( NAT +) D+/R− KT s increased from 1/month in 2015 to 22/month in 2018 ( LT s: 0/month to 12/month). HCV ‐aviremic (Ab+/ NAT ‐) D+/R− KT s increased from < 1/month in 2015 to 26/month in 2018 ( LT s: <1/month to 8/month). HCV ‐ recipients of viremic and aviremic kidneys spent a median (interquartile range [ IQR ]) of 0.7 (0.2‐1.6) and 1.6 (0.4‐3.5) years on the waitlist versus 1.8 (0.5‐4.0) among HCV D−/R−. HCV ‐ recipients of viremic and aviremic livers had median ( IQR ) MELD scores of 24 (21‐30) and 25 (21‐32) at transplantation versus 29 (23‐36) among HCV D−/R−. 12 KT and 14 LT centers performed 81% and 76% of all viremic HCV D+/R− transplants; 11 KT and 13 LT centers performed 76% and 69% of all aviremic HCV D+/R− transplants. There have been marked increases in HCV D +/R− transplantation, although few centers are driving this practice; centers should continue to weigh the risks and benefits of HCV D +/R− transplantation.