Hepatitis C virus infection in kidney donors
- Marion Muche, MD
Marion Muche, MD
- Charité - Medical University, Berlin, Germany
- Brian JG Pereira, MD
Brian JG Pereira, MD
- Professor of Medicine
- Tufts University School of Medicine
- Seema Baid-Agrawal, MD
Seema Baid-Agrawal, MD
- Associate Professor of Medicine
- Sahlgrenska Medical University, Gothenburg, Sweden
- Section Editors
- Daniel C Brennan, MD, FACP
Daniel C Brennan, MD, FACP
- Editor-in-Chief — Nephrology
- Section Editor — Renal Transplantation
- Professor of Medicine
- Washington University School of Medicine
- Adrian M Di Bisceglie, MD
Adrian M Di Bisceglie, MD
- Section Editor — Hepatitis C
- Chief of Hepatology
- Saint Louis University School of Medicine
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".)
The prevalence of HCV infection in the general population is approximately 2 to 3 percent worldwide . 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 18.20 percent among high-risk potential donors . In one study of 55 living, related potential donors, the prevalence of HCV was 3.6 percent .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'.)
TRANSMISSION OF HCV INFECTION BY KIDNEY TRANSPLANTATION
The risk of transmission of HCV infection associated with organ transplantation from an HCV-positive donor is significant [1,14-18]. In two reports, among recipients of organs from anti-HCV-positive donors, 14 to 100 percent tested positive for anti-HCV antibodies after transplantation, and 57 to 96 percent tested positive for HCV RNA by polymerase chain reaction (PCR) [1,14].
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- 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.
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- 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.
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- 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.
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- TRANSMISSION OF HCV INFECTION BY KIDNEY TRANSPLANTATION
- OUTCOMES OF TRANSPLANTATION OF HCV-POSITIVE KIDNEY
- Compared with HCV-negative kidneys
- Compared with waitlisted patients
- Among HCV-positive recipients
- IDENTIFICATION OF HCV INFECTION AMONG DONORS
- Deceased donors
- Living donors
- APPROACH TO THE USE OF KIDNEYS FROM DONORS WITH HCV INFECTION
- Deceased donors with HCV infection
- Living donors with HCV infection
- SUMMARY AND RECOMMENDATIONS