Expanding the Kidney Donor Pool through Use of Hepatitis C-Infected Donors: is it Time to Dive in?

The survival benefit of kidney transplantation for patients with end-stage renal disease (ESRD) is well established. However, the demand for kidney donor organs greatly exceeds the current supply. The use of hepatitis C infected donors could increase the number of kidneys available for transplantation. The use of highly effective second-generation direct acting antivirals (DAAs) has been recently studied for the prevention of chronic hepatitis C virus (HCV) infection in kidney transplant recipients who are HCV negative and receive HCV infected kidney allografts. Small, open-label trials have demonstrated the feasibility of using DAAs as either preand post-exposure prophylaxis or as treatment after detection of HCV transmission. Short term outcomes illustrate 100% prevention of chronic HCV infection with renal function and allograft survival that are comparable to recipients of non-HCV infected kidney donors. Long-term allograft and patient outcomes are required to determine whether the use of HCV infected organs should be considered for all patients with ESRD waiting for kidney transplant. The survival benefit of kidney transplantation for patients with end-stage renal disease (ESRD) is well established [1,2]. However, the demand for kidney donor organs greatly exceeds the current supply which encourages organ procurement organizations and transplant centers to look for innovative strategies to increase the donor pool. Recently, the opioid crisis has increased the number of overdose deaths exponentially [3]. Additionally, the number of hepatitis C virus (HCV) seropositive donors increased from 452 organs per year to 1506 per year between the years of 2000 and 2016 but only 57% of the HCV seropositive kidneys were transplanted in 2016 [4]. The use of hepatitis C infected donors could increase the number of kidneys available for transplantation but this strategy has historically been avoided because of risk of HCV transmission as well as inadequate treatment response and risk of rejection with interferon-based regimens. The advent of highly effective secondgeneration direct acting antivirals (DAAs) has increased viral cure of patients with chronic HCV infection to more than 96% [5-7]. Ongoing research is investigating whether DAAs can be prescribed post-transplant to HCV negative recipients receiving HCV infected donors to increase the donor pool.