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Hepatitis C virus infection in kidney donors

Marion Muche, MD
Seema Baid-Agrawal, MD
Section Editors
Daniel C Brennan, MD, FACP
Adrian M Di Bisceglie, MD
Deputy Editor
Albert Q Lam, MD


Transplantation of a kidney from a hepatitis C virus (HCV)-infected kidney donor may cause HCV infection in the recipient [1,2]. HCV infection has been associated with increased morbidity and possibly mortality in kidney transplant recipients [3-5].

These observations have led to the development of national and international policies concerning the allocation of organs from HCV-positive or negative donors into HCV-positive or negative recipients.

This topic reviews issues surrounding HCV-infected deceased or living kidney donors. HCV infection in kidney transplant recipients, transplant candidates, and nontransplant candidate dialysis patients is discussed elsewhere. (See "Hepatitis C infection in kidney transplant candidates and recipients" and "Hepatitis C virus infection in patients on maintenance dialysis".)

Methods of screening are discussed elsewhere. (See "Screening for chronic hepatitis C virus infection".)


The prevalence of HCV infection in the general population is approximately 2 to 3 percent worldwide, although prevalence varies from region to region [6]. The best data regarding prevalence among deceased organ donors are from a study of 13,667 potential organ donors evaluated between 2004 and 2008 by 17 organ procurement organizations in the United States; HCV prevalence was 3.45 percent among normal-risk potential donors and 18.2 percent among high-risk potential donors [7]. In one study of 55 living, related potential donors, the prevalence of HCV was 3.6 percent [8]. The reported prevalence of HCV infection among renal transplant recipients is approximately 1.8 to 8 percent [9-13]. (See "Hepatitis C infection in kidney transplant candidates and recipients", section on 'Epidemiology'.)

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Literature review current through: Nov 2017. | This topic last updated: Oct 12, 2017.
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  1. Pereira BJ, Milford EL, Kirkman RL, Levey AS. Transmission of hepatitis C virus by organ transplantation. N Engl J Med 1991; 325:454.
  2. Pereira BJ, Milford EL, Kirkman RL, et al. Prevalence of hepatitis C virus RNA in organ donors positive for hepatitis C antibody and in the recipients of their organs. N Engl J Med 1992; 327:910.
  3. Morales JM, Campistol JM. Transplantation in the patient with hepatitis C. J Am Soc Nephrol 2000; 11:1343.
  4. Fabrizi F, Martin P, Ponticelli C. Hepatitis C virus infection and renal transplantation. Am J Kidney Dis 2001; 38:919.
  5. Kotton CN, Fishman JA. Viral infection in the renal transplant recipient. J Am Soc Nephrol 2005; 16:1758.
  6. Brody H. Hepatitis C. Nature 2011; 474:S1.
  7. Ellingson K, Seem D, Nowicki M, et al. Estimated risk of human immunodeficiency virus and hepatitis C virus infection among potential organ donors from 17 organ procurement organizations in the United States. Am J Transplant 2011; 11:1201.
  8. Hidalgo G, Tejani C, Clayton R, et al. Factors limiting the rate of living-related kidney donation to children in an inner city setting. Pediatr Transplant 2001; 5:419.
  9. Kliem V, Burg M, Haller H, et al. Relationship of hepatitis B or C virus prevalences, risk factors, and outcomes in renal transplant recipients: analysis of German data. Transplant Proc 2008; 40:909.
  10. Scott DR, Wong JK, Spicer TS, et al. Adverse impact of hepatitis C virus infection on renal replacement therapy and renal transplant patients in Australia and New Zealand. Transplantation 2010; 90:1165.
  11. Santos L, Alves R, Macario F, et al. Impact of hepatitis B and C virus infections on kidney transplantation: a single center experience. Transplant Proc 2009; 41:880.
  12. Baid-Agrawal S, Pascual M, Moradpour D, et al. Hepatitis C virus infection and kidney transplantation in 2014: what's new? Am J Transplant 2014; 14:2206.
  13. Baid-Agrawal S, Schindler R, Reinke P, et al. Prevalence of occult hepatitis C infection in chronic hemodialysis and kidney transplant patients. J Hepatol 2014; 60:928.
  14. Pereira BJ, Wright TL, Schmid CH, Levey AS. A controlled study of hepatitis C transmission by organ transplantation. The New England Organ Bank Hepatitis C Study Group. Lancet 1995; 345:484.
  15. Abbott KC, Lentine KL, Bucci JR, et al. The impact of transplantation with deceased donor hepatitis c-positive kidneys on survival in wait-listed long-term dialysis patients. Am J Transplant 2004; 4:2032.
  16. Vincenti F, Lake J, Wright T, et al. Nontransmission of hepatitis C from cadaver kidney donors to transplant recipients. Transplantation 1993; 55:674.
  17. Roth D, Fernandez JA, Babischkin S, et al. Detection of hepatitis C virus infection among cadaver organ donors: evidence for low transmission of disease. Ann Intern Med 1992; 117:470.
  18. Tesi RJ, Waller K, Morgan CJ, et al. Transmission of hepatitis C by kidney transplantation--the risks. Transplantation 1994; 57:826.
  19. Roth D, Zucker K, Cirocco R, et al. The impact of hepatitis C virus infection on renal allograft recipients. Kidney Int 1994; 45:238.
  20. Centers for Disease Control and Prevention (CDC). Hepatitis C virus transmission from an antibody-negative organ and tissue donor--United States, 2000-2002. MMWR Morb Mortal Wkly Rep 2003; 52:273.
  21. Daniels D, Grytdal S, Wasley A, Centers for Disease Control and Prevention (CDC). Surveillance for acute viral hepatitis - United States, 2007. MMWR Surveill Summ 2009; 58:1.
  22. Ison MG, Llata E, Conover CS, et al. Transmission of human immunodeficiency virus and hepatitis C virus from an organ donor to four transplant recipients. Am J Transplant 2011; 11:1218.
  23. Centers for Disease Control and Prevention (CDC). Transmission of hepatitis C virus through transplanted organs and tissue--Kentucky and Massachusetts, 2011. MMWR Morb Mortal Wkly Rep 2011; 60:1697.
  24. Suryaprasad A, Basavaraju SV, Hocevar SN, et al. Transmission of Hepatitis C Virus From Organ Donors Despite Nucleic Acid Test Screening. Am J Transplant 2015; 15:1827.
  25. Pirsch JD, Heisey D, D'Allesandro AM, et al. Transplantation of hepatitis C (HCV) kidneys: Defining the risks (abstract). 14th Annual Meeting of the American Society of Transplant Physicians, Chicago, May 14-17, 1995, p. 98.
  26. Bucci JR, Matsumoto CS, Swanson SJ, et al. Donor hepatitis C seropositivity: clinical correlates and effect on early graft and patient survival in adult cadaveric kidney transplantation. J Am Soc Nephrol 2002; 13:2974.
  27. Bouthot BA, Murthy BV, Schmid CH, et al. Long-term follow-up of hepatitis C virus infection among organ transplant recipients: implications for policies on organ procurement. Transplantation 1997; 63:849.
  28. Mendez R, El-Shahawy M, Obispo E, et al. Four years follow up of hepatitis C positive kidneys into hepatitis C negative recipients — Prospective study. J Am Soc Nephrol 1995; 6:1105.
  29. Natov SN, Lau JY, Ruthazer R, et al. Hepatitis C virus genotype does not affect patient survival among renal transplant candidates. The New England Organ Bank Hepatitis C Study Group. Kidney Int 1999; 56:700.
  30. Morales JM, Campistol JM, Castellano G, et al. Transplantation of kidneys from donors with hepatitis C antibody into recipients with pre-transplantation anti-HCV. Kidney Int 1995; 47:236.
  31. Ali MK, Light JA, Barhyte DY, et al. Donor hepatitis C virus status does not adversely affect short-term outcomes in HCV+ recipients in renal transplantation. Transplantation 1998; 66:1694.
  32. Morales JM, Campistol JM, Domínguez-Gil B, et al. Long-term experience with kidney transplantation from hepatitis C-positive donors into hepatitis C-positive recipients. Am J Transplant 2010; 10:2453.
  33. Woodside KJ, Ishihara K, Theisen JE, et al. Use of kidneys from hepatitis C seropositive donors shortens waitlist time but does not alter one-yr outcome. Clin Transplant 2003; 17:433.
  34. Kasprzyk T, Kwiatkowski A, Wszola M, et al. Long-term results of kidney transplantation from HCV-positive donors. Transplant Proc 2007; 39:2701.
  35. Scalea JR, Barth RN, Munivenkatappa R, et al. Shorter waitlist times and improved graft survivals are observed in patients who accept hepatitis C virus+ renal allografts. Transplantation 2015; 99:1192.
  36. Maluf DG, Archer KJ, Mas VR. Kidney grafts from HCV-positive donors: advantages and disadvantages. Transplant Proc 2010; 42:2436.
  37. Kucirka LM, Peters TG, Segev DL. Impact of donor hepatitis C virus infection status on death and need for liver transplant in hepatitis C virus-positive kidney transplant recipients. Am J Kidney Dis 2012; 60:112.
  38. Singh N, Neidlinger N, Djamali A, et al. The impact of hepatitis C virus donor and recipient status on long-term kidney transplant outcomes: University of Wisconsin experience. Clin Transplant 2012; 26:684.
  39. Mandal AK, Kraus ES, Samaniego M, et al. Shorter waiting times for hepatitis C virus seropositive recipients of cadaveric renal allografts from hepatitis C virus seropositive donors. Clin Transplant 2000; 14:391.
  40. Terrault NA, Stock PG. Management of hepatitis C in kidney transplant patients: on the cusp of change. Am J Transplant 2014; 14:1955.
  41. Goldberg DS, Abt PL, Blumberg EA, et al. Trial of Transplantation of HCV-Infected Kidneys into Uninfected Recipients. N Engl J Med 2017; 376:2394.
  42. Aeder MI, Shield CF, Tegtmeier GE, et al. Incidence and clinical impact of hepatitis C virus-positive donors in cadaveric transplantation. Transplant Proc 1993; 25:1469.
  43. http://www.publichealthreports.org/issueopen.cfm?articleID=2975 (Accessed on September 25, 2014).
  44. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6218a5.htm.
  45. Challine D, Pellegrin B, Bouvier-Alias M, et al. HIV and hepatitis C virus RNA in seronegative organ and tissue donors. Lancet 2004; 364:1611.
  46. Humar A, Morris M, Blumberg E, et al. Nucleic acid testing (NAT) of organ donors: is the 'best' test the right test? A consensus conference report. Am J Transplant 2010; 10:889.
  47. Preiksaitis JK, Cockfield SM, Fenton JM, et al. Serologic responses to hepatitis C virus in solid organ transplant recipients. Transplantation 1997; 64:1775.
  48. Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO clinical practice guidelines for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease. Kidney Int Suppl 2008; :S1.
  49. Duan KI, Englesbe MJ, Volk ML. Centers for Disease Control 'high-risk' donors and kidney utilization. Am J Transplant 2010; 10:416.
  50. Lonze BE, Dagher NN, Liu M, et al. Outcomes of renal transplants from Centers for Disease Control and Prevention high-risk donors with prospective recipient viral testing: a single-center experience. Arch Surg 2011; 146:1261.
  51. McGuire BM, Julian BA, Bynon JS Jr, et al. Brief communication: Glomerulonephritis in patients with hepatitis C cirrhosis undergoing liver transplantation. Ann Intern Med 2006; 144:735.
  52. Cruzado JM, Gil-Vernet S, Castellote J, et al. Successful treatment of chronic HCV infection should not preclude kidney donation to an HCV negative recipient. Am J Transplant 2013; 13:2773.
  53. Manns MP, Pockros PJ, Norkrans G, et al. Long-term clearance of hepatitis C virus following interferon α-2b or peginterferon α-2b, alone or in combination with ribavirin. J Viral Hepat 2013; 20:524.