LAUSR

Background. Because of the continued demand in kidney transplantation, organs from donors with risk criteria for blood-borne viruses, high Kidney Donor Profile Index (KDPI) kidneys, and hepatitis C virus (HCV)–positive kidneys are being considered. There continues to be reluctance on the part of the providers and the candidates to accept HCV-positive kidneys. Methods. We conducted a retrospective analysis of the Organ Procurement and Transplantation Network database of all adult (≥18 y old) recipients undergoing kidney transplant from May 10, 2013, to June 30, 2021. We compared patient and graft survival in candidates who received HCV-positive kidneys versus non–hepatitis C (Hep C) high KDPI kidneys by estimated posttransplant survival (EPTS) groups. Results. HCV-viremic kidneys were transplanted in 5.6% of patients in the EPTS >61% group compared with 5.1% of patients in the 21%–60% EPTS group and 1.9% of 0%–20% EPTS group (P < 0.001). Of all transplants performed in the EPTS 61%–100% group, 11.9% were KDPI >85% compared with 5.2% in the EPTS 21%–60%, and 0.5% in the EPTS 0%–20%. Patient survival was significantly longer at 1, 3, and 5 y in the EPTS >61% group who received Hep C–viremic or –nonviremic allografts compared with non–Hep C kidneys with KDPI >85%. When it comes to listing, only 25% of candidates in the EPTS >61% group were listed for Hep C nucleic acid testing–positive kidneys in 2021. Conclusions. Our findings could be used for counseling candidates on the types of kidneys they should consider for transplantation. Also, listing practices for viremic Hep C kidneys need continued re-evaluation.