Survey of Clinician Opinions on Kidney Transplantation from Hepatitis C Virus Positive Donors: Identifying and Overcoming Barriers.

Abstract

BACKGROUND:

Transplant practices related to use of organs from Hepatitis C virus infected donors (DHCV+) is evolving rapidly.

METHODS:

We surveyed U.S. kidney transplant programs by email and professional society listserv postings between 7/19-1/20 to assess attitudes, management strategies, and barriers related to use of viremic (nucleic acid testing (NAT)+) donor organs in HCV uninfected recipients.

RESULTS:

Staff at 112 unique programs responded, representing 54% of U.S. adult kidney transplant programs and 69% of adult deceased donor kidney transplant volume in 2019. Most survey respondents were transplant nephrologists (46%) or surgeons (43%). Among responding programs, 67% currently transplant DHCV antibody+/NAT- organs under a clinical protocol or as standard of care. By comparison, only 58% offer DHCV NAT+ kidney transplant to HCV- recipients, including 35% under clinical protocols, 14% as standard of care, and 9% under research protocols. Following transplant of DHCV NAT+ organs to uninfected recipients, 53% start direct acting antiviral agent (DAA) therapy after discharge and documented viremia. Viral monitoring protocols after DHCV NAT+ to HCV uninfected recipient kidney transplantation varied substantially. 56% of programs performing these transplants report having an institutional plan to provide DAA treatment if declined by the recipient's insurance. Respondents felt a mean decrease in waiting time of ≥18 months (range 0-60) justifies the practice. Program concerns related to use of DHCV NAT+ kidneys include insurance coverage concerns (72%), cost (60%), and perceived risk of transmitting resistant infection (44%).

CONCLUSIONS:

Addressing knowledge about safety and logistical/financial barriers related to use of DHCV NAT+ kidney transplantation for HCV uninfected recipients may help reduced discards and expand the organ supply.

• Authors: Krista L Lentine, John D Peipert, Tarek Alhamad, Yasar Caliskan, Beatrice P Concepcion, Rachel Forbes, Mark Schnitzler, Su-Hsin Chang, Matthew Cooper, Roy D Bloom, Roslyn B Mannon, David A Axelrod
• Journal: Kidney360 (Kidney360) Vol. 1 Issue 11 Pg. 1291-1299 (Nov 2020) ISSN: 2641-7650 [Electronic] United States
• PMID: 33251523 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Antiviral Agents

Topics

• Adult
• Antiviral Agents (therapeutic use)
• Attitude
• Hepacivirus
• Hepatitis C, Chronic (drug therapy)
• Humans
• Kidney Transplantation (adverse effects)
• Surveys and Questionnaires