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  • Title: Impact of donor hepatitis C virus infection status on death and need for liver transplant in hepatitis C virus-positive kidney transplant recipients.
    Author: Kucirka LM, Peters TG, Segev DL.
    Journal: Am J Kidney Dis; 2012 Jul; 60(1):112-20. PubMed ID: 22560841.
    Abstract:
    BACKGROUND: Only 29% of deceased donor kidney recipients with hepatitis C virus (HCV) receive HCV-positive (HCV+) kidneys. These kidneys are discarded 2.5 times more often than their HCV-negative (HCV-) counterparts, possibly due to the sense that an HCV+ kidney may adversely affect recipient liver function. The goals of this study were to characterize liver disease in HCV+ kidney recipients and compare rates of liver-related outcomes by kidney donor HCV status. STUDY DESIGN: Observational cohort study. SETTING & PARTICIPANTS: 6,250 patients with HCV who had a kidney transplant in 1995-2008 as captured in the United Network for Organ Sharing (UNOS) database. Liver-related outcomes were assessed by cross-linking with the liver waitlist and transplant data sets. PREDICTOR: HCV status of transplanted kidney. OUTCOMES: Joining the liver waitlist, receiving a liver transplant, death. MEASUREMENTS: Time to event. RESULTS: Only 63 (1%) of HCV+ kidney recipients eventually joined the liver waitlist during the 13-year study period. Those who received HCV+ kidneys had a 2.6-fold higher hazard of joining the liver list (P < 0.001); however, the absolute difference in rate of listing between recipients of HCV- and HCV+ kidneys was <2%. This is consistent with findings of only 2% lower patient survival at 3 years in HCV+ patients receiving HCV+ versus HCV- kidneys. LIMITATIONS: We lacked data for HCV viral load and genotype of both HCV+ recipients and transplanted HCV+ kidneys. CONCLUSIONS: Because transplant with an HCV+ kidney may reduce waiting-time by more than a year for an HCV+ patient and there is a high risk of kidney waitlist mortality, a 2% increased rate of adverse liver outcomes and 2% increased rate of death at 3 years should not universally preclude the use of HCV+ kidneys when the intended recipient is also HCV+.
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