Provider Attitudes toward the Use of Hepatitis C Virus-Positive Organs in Kidney Transplantation

Abstract

Background: Direct-acting antivirals have changed the landscape of hepatitis C virus (HCV) care. While transplantation with HCV-positive donor organs is increasing, little is known about providers’ attitudes toward this topic. The aim of this study is to determine providers’ attitudes toward HCV-positive kidney transplantation. Methods: Willing transplant and nontransplant nephrologists, transplant surgeons, and mid-level providers completed an online survey from April through May 2018. The survey asked about HCV knowledge and willingness to transplant HCV-positive antibody, nucleic acid testing-positive kidneys into HCV-negative recipients. Descriptive analyses including mean and median for continuous variables and frequencies for categorical variables were calculated. Results: Seven-hundred surveys were emailed and 99 providers (62 transplant nephrologists, 28 nontransplant nephrologists, 7 transplant surgeons, and 2 advanced practice providers) completed the survey (participation rate 14.1%). All providers knew that HCV was curable, with 60% believing that it had no effect on transplant success and 32% thinking it reduced transplant success. Providers were significantly more likely to offer a HCV-positive organ to HCV-positive recipients compared to HCV-negative recipients in all queried circumstances (p < 0.005 in all cases), especially with increasing impact on patient’s quality of life. While only 39% of providers would offer a HCV-positive organ for transplant to a patient without HCV if it reduced the waitlist time by 1 year, 92% would offer a HCV-positive organ if it reduced the waitlist time by 4 years. However, only 47% thought that the use of HCV-positive kidneys should be for routine care, while 38% believed it should be reserved for research purposes only. There were no significant differences between transplant and nontransplant nephrologists in attitudes toward HCV-positive kidney transplantation. Providers believed that donor organs from those who were obese, >50 years old, or had died from a cardiac arrest were significantly more likely to reduce the likelihood of a successful transplant 1-year posttransplant when compared with a HCV-positive organ (p < 0.005 in all cases). Eighty-six percent of providers had concerns about HCV curability posttransplant. Conclusion: Although 92% of providers were willing to offer a HCV-positive kidney for transplant as patient waitlist time increases, less than half supported offering HCV-positive transplantation for routine care rather than for research. The results underscore the need for further education and data about the efficacy and safety of HCV-positive kidney transplantation.

Practice Habits, Knowledge, and Attitudes of Hepatologists to Alcohol Use Disorder Medication: Sobering Gaps and Opportunities

“…Our response rate of 20% compares favorably to other transplant center survey studies which achieved a response rate of 14%. 22 There has been another survey among liver transplant centers with a higher response rate; however, this study utilized a more selective criteria to define their population (70% of our total study population). 23 We are confident that the key patterns of AUD medication prescribing among hepatology providers are captured at liver transplant centers who manage patients with ALD both in the transplant and nontransplant realms.…”

Economic Considerations in Using HCV and HIV Positive Donors for Kidney Transplant

“…Based on the current mortality rate of the opioid epidemic, HCV viremic organs are projected to represent 10-15% of the deceased donor organ pool in America [10]. Previously, fewer than half of healthcare providers felt that transplant of an organ from a donor with viremic HCV (HCV D+) into a disease-free recipient (R-) should be a part of the standard of care [4]. More recently, acceptance of this practice has been steadily increasing.…”

“…While dialysis serves as a bridge to kidney transplant, the demand for organs continues to outstrip the available supply [2]. The waitlist for kidney transplantation has exceeded 100 000 patients [3], with only 9.1% of these patients receiving a kidney transplant after 5 years [4]. A novel method to increase the donor pool has been to consider transplanting organs from deceased patients who have had Hepatitis C Virus (HCV) or Human Immunodeficiency Virus (HIV) infections [5,6].…”

“…Over the last few decades, there has also been an increasing incidence of HCV, associated with the rise of injection opioid use [8]. HCV has a 1-2% prevalence among the American population and represents at least 4% of the potential organ donors [4]. Organ procurement from patients with HCV is projected to increase due to deaths caused by the opioid epidemic [9,10].…”

Systematic review: hepatitis C viraemic allografts to hepatitis C‐negative recipients in solid organ transplantation

“…Thus, the transplant community is exploring other potential donors, including those with active HCV. The limiting factors for utilizing HCV allografts include patient scepticism about receiving infected organs and physician concerns about post‐transplant complications 6‐8 …”