More than half of donor kidneys in the United State infected with hepatitis C are thrown away, despite the need among hepatitis C patients who may die waiting for an infection-free organ, Johns Hopkins research suggests.
In a study of national data published online in the American Journal of Transplantation, the researchers say that while outcomes are slightly worse when hepatitis C-positive patients receive hepatitis C-positive organs, the advantages of more timely transplants may outweigh the risk of waiting — perhaps more than year — for a hepatitis C-negative kidney.
Patients with hepatitis C-positive make up about 12 percent of the population with kidney failure, and those patients have an increased risk of death on dialysis compared with those without the virus, the study says.
“Nationwide, kidneys from infected donors are inappropriately thrown out and denied to patients in need,” says transplant surgeon Dorry L. Segev, MD, PhD, an associate professor of surgery at the Johns Hopkins University School of Medicine and the study’s leader. “Many transplant centers don’t use these kidneys at all, effectively consigning hepatitis C-positive patients to an average unnecessary wait of a year longer for an uninfected organ.” That, he says, “means an extra year on dialysis, in which the risk of death is 10 to 15 percent.”
The use of hepatitis C-positive kidneys has been controversial in the past, owing in part to a 1 percent difference in one-year survival for patients who receive the infected kidneys and a 2 percent difference in three-year survival. Segev says this difference “is easily made up for by getting off dialysis sooner.”
Hepatitis C-positive kidneys rarely go to hepatitis C-negative patients because the organ would infect the recipient with the chronic liver disease.
In looking at data from more than 93,000 deceased kidney donors between 1995 and 2009, Segev and his colleagues found that hepatitis C-positive kidneys were two and a half times more likely to be discarded than hepatitis C-negative kidneys. Since 1995, more than 3,500 hepatitis C-positive kidneys were thrown away.
“That’s a lot of kidneys we could have transplanted into people who need them,” Segev says.
Meanwhile, he adds, some 4,800 hepatitis C patients got hepatitis C-negative kidneys. “Using hepatitis C-positive kidneys in people who are infected with the virus could help those with hepatitis C and also expand the organ supply for everyone.”
One-third of the nation’s transplant centers, according to the study, did not use any hepatitis C-positive kidneys for their hepatitis C patients, while 13 percent transplanted more than half of their hepatitis C patients with hepatitis C-positive kidneys.
At The Johns Hopkins Hospital, where doctors specialize in patients with hepatitis C and kidney failure, a patient with hepatitis C could likely be successfully transplanted with a hepatitis C-positive kidney within several months of being put on the waiting list, Segev says. Recipients of hepatitis C-positive kidneys waited, on average, 395 days less than those recipients who waited for hepatitis C-negative kidneys at the same transplant center, the study shows.
Other Johns Hopkins researchers on the study include Lauren M. Kucirka, ScM; Andrew L. Singer, MD, PhD; R. Loris Ros, ScM; Robert A. Montgomery, MD, PhD; and Nabil N. Dagher, MD.
Dear Helpdesk: Working in a Toxic Health Care Environment
March 28th 2024Dear Helpdesk is your steadfast companion, offering life coaching and workplace advice from 2 seasoned IPs for some of your most challenging real-life situations. Let us help you navigate the intersection between work and life, guiding you to navigate the dynamic world of infection prevention with confidence and grace. This article is on handling a toxic health care environment.
Product Locator: Spring and Early Mother's Day Gift Guide for Infection Prevention Personnel
March 27th 2024Whether it's a spring holiday, birthdays, or no reason at all, infection prevention personnel love to give and receive gifts that help at the end of a stressful day. Infection Control Today® offers some gift ideas for infection prevention personnel and their families.
Catching Up With Vangie Dennis, AORN 2022-2023 President at AORN 2024
March 26th 2024Infection Control Today (ICT) had the privilege of catching up with Vangie Dennis, MSN, RN, CNOR, CMLSO, at the Association of periOperative Registered Nurses' (AORN’s) International Surgical Conference & Expo 2024. As the former president of AORN and an esteemed figure in perioperative services, Vangie Dennis shared insights into her recent endeavors and the exciting new chapter she's embarked upon.
How To Optimize Your Time Management Strategies for the Busy Infection Preventionist
March 25th 2024Is your calendar resembling a chaotic masterpiece of overlapping tasks? Join the club of infection preventionists striving to balance responsibilities. Dive into proven strategies from a fellow infection preventionist to reclaim control of your time, streamline tasks, and boost productivity effectively. This is an IP Lifeline article.