April 12, 2010

Donor kidneys from hepatitis C patients needlessly denied

More than half of donor kidneys in the United States infected with hepatitis C are thrown away despite the need among hepatitis C patients who may die waiting for an infection-free organ, Johns Hopkins research suggests.

In a study of national data published online in the American Journal of Transplantation, the researchers say that while outcomes are slightly worse when hepatitis C–positive patients receive hepatitis C–positive organs, the advantages of more timely transplants may outweigh the risk of waiting—perhaps more than a year—for a hepatitis C–negative kidney.

Patients with hepatitis C–positive make up about 12 percent of the population with kidney failure, and those patients have an increased risk of death on dialysis compared with those without the virus, the study says.

“Nationwide, kidneys from infected donors are inappropriately thrown out and denied to patients in need,” said transplant surgeon Dorry L. Segev, an associate professor of surgery at the Johns Hopkins University School of Medicine and the study’s leader. “Many transplant centers don’t use these kidneys at all, effectively consigning hepatitis C–positive patients to an average unnecessary wait of a year longer for an uninfected organ. That,” he said, “means an extra year on dialysis, in which the risk of death is 10 to 15 percent.”

The use of hepatitis C–positive kidneys has been controversial in the past, owing in part to a 1 percent difference in one-year survival for patients who receive the infected kidneys and a 2 percent difference in three-year survival. Segev said that this difference “is easily made up for by getting off dialysis sooner.”

Hepatitis C–positive kidneys rarely go to hepatitis C–negative patients because the organ would infect the recipient with the chronic liver disease.

In looking at data from more than 93,000 deceased kidney donors between 1995 and 2009, Segev and his colleagues found that hepatitis C–positive kidneys were two and a half times more likely to be discarded than hepatitis C–negative kidneys. Since 1995, more than 3,500 hepatitis C–positive kidneys have been thrown away.

“That’s a lot of kidneys we could have transplanted into people who need them,” Segev said.

Meanwhile, he added, some 4,800 hepatitis C patients got hepatitis C–negative kidneys. “Using hepatitis C–positive kidneys in people who are infected with the virus could help those with hepatitis C and also expand the organ supply for everyone.

“One-third of the nation’s transplant centers, according to the study, did not use any hepatitis C–positive kidneys for their hepatitis C patients, while 13 percent transplanted more than half their hepatitis C patients with hepatitis C–positive kidneys,” Segev said.

At The Johns Hopkins Hospital, where doctors specialize in patients with hepatitis C and kidney failure, a patient with hepatitis C could likely be successfully transplanted with a hepatitis C–positive kidney within several months of being put on the waiting list, Segev said. Recipients of hepatitis C–positive kidneys waited, on average, 395 days less than those recipients who waited for hepatitis C–negative kidneys at the same transplant center, the study shows.

Other Johns Hopkins researchers on the study are Lauren M. Kucirka, Andrew L. Singer, R. Loris Ros, Robert A. Montgomery and Nabil N. Dagher.

Related Web site

Dorry Segev

Johns Hopkins Comprehensive Transplant Center