Exploring patient willingness to accept hepatitis C-infected kidneys for transplantation

Abstract

Background As organs infected with Hepatitis C virus (HCV) provide an opportunity to expand the donor pool, the primary aim of this study is to explore patient willingness to accept a kidney from HCV-infected donors compared to other high-risk donors. Methods An anonymous, electronic survey was sent to all active kidney transplant waitlist patients at a single large volume transplant center. Patients were asked to respond to three hypothetical organ offers from the following: 1) HCV-infected donor 2) Donor with active intravenous drug use and 3) Donor with longstanding diabetes and hypertension. Results The survey was sent to 435 patients of which 125 responded (29% response rate). While 86 out of 125 patients (69%) were willing to accept an HCV-infected kidney, only a minority of respondents were willing to accept a kidney from other high-risk donors. In contrast to other studies, by multivariable logistic regression, age and race were not associated with willingness to accept an HCV-infected kidney. Conclusions In this exploratory study, utilization of kidneys from HCV-infected donors to expand the donor pool appears to be an acceptable option to patients.

Clinician and patient attitudes toward use of organs from hepatitis C viremic donors and their impact on acceptance: A contemporary review

“…Patients and providers appear concerned with DAA costs and insurance coverage, a recurring theme in all of the studies reviewed. Patients demonstrated worry about whether insurance would cover their copays 9,19 and expressed apprehension towards the increased number and frequency of office visits required for HCV treatment initiation and monitoring 14,19 . Providers noted concerns regarding high costs both to the patient and to the program 10 .…”

“…Patients demonstrated worry about whether insurance would cover their copays 9,19 and expressed apprehension towards the increased number and frequency of office visits required for HCV treatment initiation and monitoring. 14,19 Providers noted concerns regarding high costs both to the patient and to the program. 10 These concerns appear justified: although 73.2% of post-transplant patients surveyed did not pay a copay, 16.3% found costs were higher than anticipated; and of patients with a household income of < $20 000, some copay was still required for 20%.…”

“…Among NAT-positive organ accepting patients surveyed post-transplantation, 67.3% cited decreased waitlist time as their reason to accept viremic organs. 13 Most pre-transplant patients cited a decrease in waiting time of 3-3.5 years as an incentive to accept these organs 12,19 ; however, a time reduction as small as 6 months caused a 15% increase in acceptance. 9 Providers were also affected by the thought of decreased waitlist time, with Lentine et al finding a mean reduction of 18 months to be perceived as a sufficient waiting time reduction to accept an HCV NAT-positive organ.…”

Association of donor hepatitis C virus infection status and risk of BK polyomavirus viremia after kidney transplantation

“…An increasing number of transplant programs are accepting these kidneys, 9 either in the setting of clinical trials 5–8 or in real‐world settings 4,10 . Moreover, a study of decision‐making by HCV‐naïve candidates suggested that most were willing to accept HCV‐infected kidneys under at least some circumstances, such as a kidney from a young donor 11,12 . A single‐center trial and national cohort studies using OPTN registry data have demonstrated that 1‐year allograft function after transplantation is similar between recipients of HCV‐infected kidneys and recipients of kidneys from matched donors without HCV 4,5,9,13 .…”

“…4,10 Moreover, a study of decision-making by HCV-naïve candidates suggested that most were willing to accept HCV-infected kidneys under at least some circumstances, such as a kidney from a young donor. 11,12 A singlecenter trial and national cohort studies using OPTN registry data have demonstrated that 1-year allograft function after transplantation is similar between recipients of HCV-infected kidneys and recipients of kidneys from matched donors without HCV. 4,5,9,13 However, important concerns have emerged suggesting that donor-derived HCV viremia might be associated with unexpected immunological complications such as BK polyomavirus (BKPyV) infection.…”