Association of willingness to accept a Hepatitis C status donor kidney on access to transplant

BACKGROUND: The approval development of curative therapy for Hepatitis C (HCV) created the ability to safely utilize kidneys recovered from donors testing positive for HCV. We evaluate the association of kidney transplant candidates’ willingness to accept a HCV positive donor kidney on access to deceased donor kidney transplant (DDKT), and the utilization of such donors kidneys more broadly. METHODS: This study used data from the Scientific Registry of Transplant Recipients and included all candidates for DDKT on the waiting list between Jan. 1, 2015 and Mar. 12, 2020 (n= 233,033). Cox models with time to transplant were constructed to evaluate the association of willingness to accept a kidney from a HCV positive donor with kidney transplant rate. RESULTS: Willingness to accept a HCV positive donor was associated with increased access to transplant for all waitlisted patients. Transplant rates for candidates willing to accept a HCV positive donor were 0.296 transplants per person years waiting compared to 0.132 transplants per person years waiting for candidates who were never willing to accept such donors. 8.3 % of all candidates waitlisted patients indicated willingness at listing while an additional 9.7% of the remaining waitlisted patients indicated willingness at later date with median time to willingness being 55 days (IQR:0-719 days) after listing. Among candidates waitlisted patients who were ever willing to accept a HCV positive donor, 62.9% were male, 55.5% were White, and 51.4% attained a high school degree or higher. The numbers of DDKT using kidneys from HCV + donors increased during the study period, however, the non-use of such kidneys has increased. CONCLUSION: Interventions targeting willingness to accept a HCV positive donor may simultaneously increase access to transplant and support policies to reduce organ non-use.