Given the global organ shortage for transplantation, use of expanded criteria donors and donors with potentially transmissible diseases has been established as a way to mitigate this problem somewhat. While there is universal consensus on rejecting kidneys from HCV antibody positive donors for transplantation in HCV antibody negative recipients, there is controversy regarding the use of these kidneys for HCV antibody positive recipients. Well, we have the first study that reported the long-term experience in this area (Morales et al, Am J Transplant. Nov 2010). This study was done in Spain. Outcomes of 162 HCV antibody positive recipients (97% of them are HCV RNA positive as well) that received a kidney from HCV antibody positive donors were compared with outcomes of 306 HCV antibody positive recipients that recieved kidney from HCV antibody negative donors. Mean follow-up was 74.5 months. There was no difference in patient survial and decompensated liver disease between the two groups. 5-year and 10-year graft survival was 58.9% and 34.4% versus 65.5% and 47.6% respectively (p = 0.006) while death-censored graft survival was 69% and 47% versus 72.7% and 58.5% (p = 0.055). Cox-regression analysis could not identify the donor's HCV serology as a significant risk factor for death, graft failure and severe liver disease in HCV antibody positive recipients. These findings prove that use of this strategy is safe and helps the problem of severe organ shortage that we are facing now.
Tuesday, October 26, 2010
Outcomes of kidney transplantation from HCV positive donors
Given the global organ shortage for transplantation, use of expanded criteria donors and donors with potentially transmissible diseases has been established as a way to mitigate this problem somewhat. While there is universal consensus on rejecting kidneys from HCV antibody positive donors for transplantation in HCV antibody negative recipients, there is controversy regarding the use of these kidneys for HCV antibody positive recipients. Well, we have the first study that reported the long-term experience in this area (Morales et al, Am J Transplant. Nov 2010). This study was done in Spain. Outcomes of 162 HCV antibody positive recipients (97% of them are HCV RNA positive as well) that received a kidney from HCV antibody positive donors were compared with outcomes of 306 HCV antibody positive recipients that recieved kidney from HCV antibody negative donors. Mean follow-up was 74.5 months. There was no difference in patient survial and decompensated liver disease between the two groups. 5-year and 10-year graft survival was 58.9% and 34.4% versus 65.5% and 47.6% respectively (p = 0.006) while death-censored graft survival was 69% and 47% versus 72.7% and 58.5% (p = 0.055). Cox-regression analysis could not identify the donor's HCV serology as a significant risk factor for death, graft failure and severe liver disease in HCV antibody positive recipients. These findings prove that use of this strategy is safe and helps the problem of severe organ shortage that we are facing now.
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