| Abstract: | 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. |
