Outcomes associated with recipient and donor hepatitis C serology status after kidney transplantation in the United States: analysis of the USRDS/UNOS database.

Analysis of the USRDS kidney transplant registry disclosed that use of hepatitis C virus-positive donor (DHCV+) kidneys was an independent risk factor for patient death after kidney transplantation when compared to use of DHCV- kidneys, and that death in recipients of DCHV+ kidneys occurred earlier than previously reported. This increased risk of death was delayed for about 2 years, suggesting the development of an intermediate complication that resulted in a later increased risk of death. While liver disease early after transplant in these patients was rare, new-onset diabetes mellitus occurred early and commonly, suggesting this complication as a prominent mediator of mortality associated with transplantation with DHCV+ kidneys. Identification of new-onset diabetes mellitus may represent a new target of opportunity to improve outcomes associated with use of DHCV+ kidneys. Even under the current circumstances, use of DHCV+ kidneys was also independently associated with a survival experience that, although less favorable than associated with transplantation of DHCV- kidneys, was significantly better than remaining on the kidney transplant waiting list. Whether this survival advantage applies to all relevant subgroups could not be assessed and warrants further study. Our analyses suggest opportunities to improve survival and reduce morbidity after use of DHCV+ kidneys.