Hepatitis C virus (HCV) infection is transmissible through organ donation and most nations ban the use of kidneys from donors who are seropositive for HCV. However, with demands for transplantation greatly exceeding the supply of donated kidneys, should organs from these donors really be going to waste? For the past 20 years, researchers from Spain have been transplanting kidneys from HCV-seropositive donors into HCV-seropositive recipients. Their long-awaited data show that this controversial practice can be safe in some circumstances, and may even help to mitigate the global shortage of donated kidneys.
In the early years of this study, Jose Morales et al. discovered that viral load increased after transplantation in four of five HCV-seropositive recipients who did not have an active infection (viral load <100 copies per ml of HCV RNA) prior to receiving a kidney transplant from an HCV-seropositive donor. After 1993, the team limited the use of kidneys from these donors to recipients with an active HCV infection at the time of transplantation, with improved results. “It is possible to transplant kidneys from HCV-seropositive donors into HCV-RNA-positive recipients safely,” confirms Morales, corresponding author of the study. Of 468 HCV-seropositive transplant recipients, 162 received a kidney from an HCV-seropositive donor, and the remainder received organs from HCV-seronegative donors. “Long-term patient survival, graft survival and rates of liver disease are favorable and similar to those obtained with transplantation using kidneys from HCV-seronegative donors,” he continues.
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