Center-level trends in utilization of HCV-exposed donors for HCV-uninfected kidney and liver transplant recipients in the United States

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Several single-center reports of using HCV-viremic organs for HCV-uninfected (HCV-) recipients were recently published. We sought to characterize national utilization of HCV-exposed donors for HCV- recipients (HCV D+/R−) in kidney transplantation (KT) and liver transplantation (LT). Using SRTR data (April 1, 2015-December 2, 2018) and Gini coefficients, we studied center-level clustering of 1193 HCV D+/R− KTs and LTs. HCV-viremic (NAT+) D+/R− KTs increased from 1/month in 2015 to 22/month in 2018 (LTs: 0/month to 12/month). HCV-aviremic (Ab+/NAT-) D+/R− KTs increased from < 1/month in 2015 to 26/month in 2018 (LTs: <1/month to 8/month). HCV- recipients of viremic and aviremic kidneys spent a median (interquartile range [IQR]) of 0.7 (0.2-1.6) and 1.6 (0.4-3.5) years on the waitlist versus 1.8 (0.5-4.0) among HCV D−/R−. HCV- recipients of viremic and aviremic livers had median (IQR) MELD scores of 24 (21-30) and 25 (21-32) at transplantation versus 29 (23-36) among HCV D−/R−. 12 KT and 14 LT centers performed 81% and 76% of all viremic HCV D+/R− transplants; 11 KT and 13 LT centers performed 76% and 69% of all aviremic HCV D+/R− transplants. There have been marked increases in HCV D+/R− transplantation, although few centers are driving this practice; centers should continue to weigh the risks and benefits of HCV D+/R− transplantation.

Original languageEnglish (US)
JournalAmerican Journal of Transplantation
StatePublished - Jan 1 2019



  • clinical research/practice
  • hepatitis C
  • infection and infectious agents - viral
  • infectious disease
  • kidney transplantation/nephrology
  • liver transplantation/hepatology
  • Organ Procurement and Transplantation Network (OPTN)
  • Scientific Registry for Transplant Recipients (SRTR)

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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