Provider Attitudes toward the Use of Hepatitis C Virus-Positive Organs in Kidney Transplantation.

Autor:	Couri T; Department of Internal Medicine, University of Chicago Medical Center, Chicago, Illinois, USA, thomas.couri@uchospitals.edu., Katz J; Department of Internal Medicine, University of Chicago Medical Center, Chicago, Illinois, USA., Stoeckle K; New York Presbyterian/Weill Cornell Medical Center, Department of Internal Medicine, New York, New York, USA., Nugooru A; Virginia Commonwealth University Medical School, Richmond, Virginia, USA., Yeh H; Department of Surgery, Section of Transplant Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA., Chung R; Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA., Paul S; Center for Liver Diseases, University of Chicago, Chicago, Illinois, USA.
Jazyk:	angličtina
Zdroj:	American journal of nephrology [Am J Nephrol] 2019; Vol. 50 (3), pp. 168-176. Date of Electronic Publication: 2019 Aug 07.
DOI:	10.1159/000502049
Abstrakt:	Background: Direct-acting antivirals have changed the landscape of hepatitis C virus (HCV) care. While transplantation with HCV-positive donor organs is increasing, little is known about providers' attitudes toward this topic. The aim of this study is to determine providers' attitudes toward HCV-positive kidney transplantation. Methods: Willing transplant and nontransplant nephrologists, transplant surgeons, and mid-level providers completed an online survey from April through May 2018. The survey asked about HCV knowledge and willingness to transplant HCV-positive antibody, nucleic acid testing-positive kidneys into HCV-negative recipients. Descriptive analyses including mean and median for continuous variables and frequencies for categorical variables were calculated. Results: Seven-hundred surveys were emailed and 99 providers (62 transplant nephrologists, 28 nontransplant nephrologists, 7 transplant surgeons, and 2 advanced practice providers) completed the survey (participation rate 14.1%). All providers knew that HCV was curable, with 60% believing that it had no effect on transplant success and 32% thinking it reduced transplant success. Providers were significantly more likely to offer a HCV-positive organ to HCV-positive recipients compared to HCV-negative recipients in all queried circumstances (p < 0.005 in all cases), especially with increasing impact on patient's quality of life. While only 39% of providers would offer a HCV-positive organ for transplant to a patient without HCV if it reduced the waitlist time by 1 year, 92% would offer a HCV-positive organ if it reduced the waitlist time by 4 years. However, only 47% thought that the use of HCV-positive kidneys should be for routine care, while 38% believed it should be reserved for research purposes only. There were no significant differences between transplant and nontransplant nephrologists in attitudes toward HCV-positive kidney transplantation. Providers believed that donor organs from those who were obese, >50 years old, or had died from a cardiac arrest were significantly more likely to reduce the likelihood of a successful transplant 1-year posttransplant when compared with a HCV-positive organ (p < 0.005 in all cases). Eighty-six percent of providers had concerns about HCV curability posttransplant. Conclusion: Although 92% of providers were willing to offer a HCV-positive kidney for transplant as patient waitlist time increases, less than half supported offering HCV-positive transplantation for routine care rather than for research. The results underscore the need for further education and data about the efficacy and safety of HCV-positive kidney transplantation. (© 2019 S. Karger AG, Basel.)
Databáze:	MEDLINE
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