Transplantation of kidneys from hepatitis C virus (HCV)-viremic donors into HCV-negative patients followed by direct-acting antiviral therapy was an important breakthrough to increase the number of lifesaving kidney transplants. Data suggest these transplants offer several benefits, however it is unknown whether adoption of this practice has been shared equitably, especially among disadvantaged groups.
We evaluated United Network for Organ Sharing data on HCV-seronegative adult deceased-donor kidney transplant (DDKT) recipients from 1/1/2017-6/12/2020. We compared recipients of a kidney from an HCV Ab-/nucleic acid test -(NAT-), HCV Ab+/NAT-, and HCV NAT+ donor. The primary covariates were: 1) race/ethnicity; 2) female sex; and 3) highest level of education. Models included variables associated with being offered an HCV NAT+ kidney. We fit mixed-effects multinomial logistic regression models with center as a random effect to account for patient clustering.
Of 48,255 adult kidney-alone DDKT HCV-seronegative recipients, 1,641 (3.4%) donors were HCV NAT+-, increasing from 0.3% (1/2017-6/2017) to 6.9% (1/2020-6/2020). In multivariable models, racial/ethnic minorities, women, and those with less education were significantly less likely to receive a kidney from an HCV NAT+ donor relative to an HCV Ab-/NAT- and HCV Ab+/NAT- donor. The disparities were most pronounced among Hispanic and Asian patients with less educational attainment (grade school, high school, or some college/tech school).
Despite an increase in transplants from HCV NAT+ donors, we found substantial racial/ethnic disparities in transplantation of these kidneys. These data highlight how the benefits of a scientific breakthrough are often made less available to disadvantaged patients.