National Trends in Utilization and 1-Year Outcomes with Transplantation of HCV-Viremic Kidneys
| Autor: | Meghan E. Sise, Roy D. Bloom, Peter P. Reese, K. Rajender Reddy, James E. Sharpe, Miklos Z. Molnar, Deirdre Sawinski, Peter L. Abt, David S. Goldberg, Chirag R. Parikh, Sumit Mohan, Vishnu S. Potluri, Emily A. Blumberg |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Tissue and Organ Procurement 030232 urology & nephrology Urology 030230 surgery Kidney transplant 03 medical and health sciences 0302 clinical medicine Up Front Matters medicine Humans Viremia National trends Kidney transplantation Aged Retrospective Studies Matching methods Hepatitis Kidney business.industry virus diseases General Medicine Middle Aged medicine.disease Hepatitis C Kidney Transplantation Tissue Donors United States digestive system diseases Transplantation Treatment Outcome medicine.anatomical_structure Nephrology Female Registry data business Procedures and Techniques Utilization |
| Zdroj: | J Am Soc Nephrol |
| ISSN: | 1533-3450 1046-6673 |
| DOI: | 10.1681/asn.2019050462 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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