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Race, Risk, and Willingness of End-Stage Renal Disease Patients Without Hepatitis C Virus to Accept an HCV-Infected Kidney Transplant.

Abstract：

BACKGROUND:Despite effective antiviral treatment, hundreds of kidneys from deceased donors with hepatitis C virus (HCV) are discarded annually. Little is known about the determinants of willingness to accept HCV-infected kidneys among HCV-negative patients. METHODS:At 2 centers, 189 patients undergoing initial or reevaluation for transplant made 12 hypothetical decisions about accepting HCV-infected kidneys in which we systematically varied expected HCV cure rate, allograft quality, and wait time for an uninfected kidney. RESULTS:Only 29% of the participants would accept an HCV-infected kidney under all scenarios, whereas 53% accepted some offers and rejected others, and 18% rejected all HCV-infected kidneys. Higher cure rate (odds ratio [OR], 3.49; 95% confidence interval [CI], 2.33-5.24 for 95% vs 75% probability of HCV cure), younger donor (OR, 2.34; 95% CI, 1.91-2.88 for a 20-year-old vs a 60-year-old hypertensive donor), and longer wait for an uninfected kidney (OR, 1.43; 95% CI, 1.22-1.67 for 5 years vs 2 years) were associated with greater willingness to accept an HCV-infected kidney. Black race modified the effect of HCV cure rate, such that willingness to accept a kidney increased less for blacks versus whites as the cure rate improved. Patients older than 60 years and prior kidney recipients showed greater willingness to accept an HCV-infected organ. CONCLUSIONS:Most patients will consider an HCV-infected kidney in some situations. Future trials using HCV-infected kidneys may enhance enrollment by targeting older patients and prior transplant recipients, but centers should anticipate that black patients' acceptance of HCV-infected kidneys will be reduced compared with white patients.

journal_name

Transplantation

journal_title

Transplantation

authors

McCauley M,Mussell A,Goldberg D,Sawinski D,Molina RN,Tomlin R,Doshi SD,Abt P,Bloom R,Blumberg E,Kulkarni S,Esnaola G,Shults J,Thiessen C,Reese PP

doi

10.1097/TP.0000000000002099

subject

Has Abstract

pub_date

2018-04-01 00:00:00

pages

e163-e170

issue

eissn

0041-1337

issn

1534-6080

journal_volume

102

pub_type

杂志文章

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Race, Risk, and Willingness of End-Stage Renal Disease Patients Without Hepatitis C Virus to Accept an HCV-Infected Kidney Transplant.