The Impact of the Modified Kidney Donor Profile Index on the Nonuse of Kidneys From Donors With Hepatitis C

Background. Donor hepatitis C virus (HCV) status was removed from the Kidney Donor Profile Index (KDPI) in October 2024 to better align the score with contemporary outcomes. Little is known about patterns in nonuse and utilization of HCV-exposed kidneys following this revision. Methods. We analyzed Organ Procurement and Transplantation Network data for 145 425 deceased donor kidneys recovered for transplantation between January 2020 and June 2025. Donor HCV status was categorized as nucleic acid test (NAT) + , NAT − /antibody (Ab) + , or NAT − /Ab − . Multivariable logistic regression adjusted for donor characteristics was used to evaluate kidney nonuse. Multinomial logistic regression adjusted for donor and recipient characteristics was used to assess donor HCV status among transplanted kidneys. Results. Through 2024, kidneys from both NAT + and NAT − /Ab + donors had higher adjusted odds of nonuse than NAT − /Ab − kidneys. In early 2025, NAT + kidneys had their lowest observed adjusted odds ratio (aOR) of nonuse during the study period but remained significantly higher than NAT − /Ab − kidneys (aOR, 1.30; 95% confidence interval [CI], 1.01-1.67), whereas NAT − /Ab + kidneys attenuated to nonsignificance (aOR, 1.19; 95% CI, 0.84-1.72). Despite increased candidate willingness to accept both NAT + and NAT − /Ab + kidneys from 2020 to 2025, the odds of transplanting NAT + compared with NAT − /Ab − kidneys did not increase after the KDPI revision (aOR, 0.99; 95% CI, 0.88-1.12). However, transplanting NAT − /Ab + kidneys increased (aOR, 1.27; 95% CI, 1.13-1.43). Conclusions. Removal of HCV from the KDPI equation has improved utilization of NAT − /Ab + kidneys, whereas NAT + kidneys continued to experience excess nonuse despite rising candidate willingness to accept HCV-exposed kidneys.