Effect of Hepatitis C Virus Infection on Outcomes After Kidney Transplantation

Abstract

Hepatitis C Virus (HCV) infection in a donor, recipient, or both affects deceased-donor kidney transplantation outcomes. Direct-acting antivirals (DAA) may influence those outcomes. The Organ Procurement and Transplantation Network (OPTN) data of adult first-time solitary deceased-donor kidney transplant recipients 1994-2019 were allocated into four groups by donor or recipient HCV infection. We performed patient survival (PS) and death-censored graft survival (DCGS) pairwise comparisons after propensity score matching to assess donors and/or recipients HCV infection effect. We stratified our study by DAA era to evaluate for potential effect modification. In the pre-DAA era, donor HCV infection decreased PS and DCGS in all recipients. However, recipient HCV infection impaired PS and DCGS only with uninfected donors. HCV dual-infection (donor plus recipient) group had worse PS and DCGS than the dual-uninfected. Donor HCV infection derived worse post-transplant outcomes than recipient HCV infection. The risk associated with HCV infection in donors and/or recipients was no longer statistically significant in the post-DAA era, except for impaired PS in dual-infected versus dual-uninfected. Kidney donor HCV infection negatively affected transplant outcomes in all recipients, while recipient HCV infection impaired outcomes only with uninfected donors. Early post-DAA era analysis showed no effect of donor or recipient HCV infection.