Factors associated with hepatitis C antibody seroconversion after transplantation of kidneys from hepatitis C infected donors to hepatitis C naïve recipients

Abstract

Background

We aimed to assess the probability and factors associated with the presence of hepatitis C virus (HCV) antibody among HCV seronegative kidney transplant recipients receiving HCV-infected (nucleic acid testing positive) donor kidneys.

Methods

This is a retrospective review examining HCV antibody seroconversion of all kidney transplant recipients receiving an organ from an HCV-infected donor between 1 March 2018 and 2 December 2019 at a high-volume kidney transplant center in the southeast United States.

Results

Of 97 patients receiving HCV-infected kidneys, the final cohort consisted of 85 recipients with 5 (5.9%) recipients noted to have HCV antibody seroconversion in the setting of HCV viremia. The HCV RNA level at closest time of antibody measurement was higher in the seroconverted patients versus the ones who never converted [median and (interquartile range): 1,091,500 (345,000–8,360,000) vs 71,500 (73–313,000), p = 0.02]. No other significant differences including type of immunosuppression were noted between the HCV antibody positive group and HCV antibody negative group. Donor donation after cardiac death status [Odds Ratio (OR) and 95% Confidence Interval (CI) was: 8.22 (1.14–59.14)], donor age [OR (95% CI) (+5 years) was: 3.19 (1.39–7.29)] and Kidney Donor Profile Index [OR (95% CI) (+1) was:1.07 (1.01–1.15)] showed a statistically significant association with HCV seroconversion.

Conclusions

HCV antibody should not be considered routine screening for presence of infection in previously HCV naïve kidney transplant recipients receiving kidneys from HCV-infected donors, as only a modest percentage have antibody despite active viremia. The assessment of HCV viral load should be routine in all transplant recipients receiving organs from public health service increased risk donors.

Keywords:

• Seroconversion
• hepatitis C virus
• transplantation
• policy

Acknowledgments

Part of this work was presented in poster format at American Transplant Congress at Philadelphia, PA in May 30-June 3, 2020 and published in abstract form at American Journal of Transplantation (https://doi.org/10.1111/ajt.16171) [22].

Author contributions

U.A. and M.Z.M. participated in research design. U.A., M.Z.M., and B.M. participated in the writing of the paper. U.A. and M.Z.M., participated in data analysis. U.A., O. C., M. Y., M. T., V. B., A. B., P. S. P., B. M., S. N., J. D. E. and M.Z.M. participated in the performance of the research.

Disclosure statement

Dr. Molnar served as advisor for Merck and AbbVie. Dr. Nair served as advisor and speaker for AbbVie and Gilead Sciences. The rest of the authors declare no conflicts of interest.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.