Hepatitis C virus (HCV)-positive patients with kidney failure may have difficulty accessing kidney transplantation—but when they do, they rapidly achieve a significant survival benefit, reports a study in the American Journal of Kidney Diseases.
The retrospective cohort study included more than 442,000 adult dialysis patients, identified from clinical data provided by a large national dialysis provider. Of these patients, 7.2% were reported as HCV-seropositive. The HCV-seropositive group were younger (median age 56 versus 64), more likely to be men (66% versus 54%), and more likely to be African American (54% versus 29%).
After linkage to Organ Procurement and Transplantation Network data, associations between HCV serostatus, mortality, and kidney transplant waitlisting were assessed. The study also estimated the survival benefit from kidney transplant for HCV-seropositive patients, compared to remaining on dialysis.
Dialysis patients who were HCV-seropositive were at modestly increased risk of death, adjusted hazard ratio (HR) 1.09; but were one-third less likely to be placed on the kidney transplant waitlist, HR 0.67. After waitlisting, the chances of kidney transplant were similar for HCV-seropositive versus HCV-seronegative patients. Waiting time was shorter for recipients of HCV-seropositive kidneys.
Kidney transplantation brought a significant survival benefit, achieved within 9 months posttransplant. By 3 years, the HR for death associated with transplantation, compared to continued waiting, was 0.42. The survival benefit of transplantation was unaffected by donor HCV serostatus.
Many ESRD patients are HCV-seropositive, which may create barriers to kidney transplantation. Because registry data lack information on HCV serostatus, little is known about survival on dialysis and the outcomes of kidney transplantation for HCV-seropositive patients.
The new study shows that ESRD patients with HCV are less likely to be waitlisted, despite deriving a substantial survival benefit from kidney transplantation. Patients receiving kidneys from HCV-seropositive donors show a survival advantage at 2 years, compared to those who remain on the waitlist. The researchers conclude, “[R]emoving barriers to waitlisting for this patient group should be a priority for providers” [Sawinski D, et al. Mortality and kidney transplantation outcomes among hepatitis C virus–seropositive maintenance dialysis patients: a retrospective cohort study. Am J Kidney Dis 2019; DOI: https://doi.org/10.1053/j.ajkd.2018.11.009].