Yuan Q, Hong S, Leya G, Roth E, Tsoulfas G, Williams W, Madsen JC, Elias N. Analysis of the effects of donor and recipient hepatitis C infection on kidney transplant outcomes in the United States. World J Transplant 2023; 13(2): 44-57 [PMID: 36908306 DOI: 10.5500/wjt.v13.i2.44]
Corresponding Author of This Article
Nahel Elias, MD, Assistant Professor, Surgeon, Transplant Center and Center for Transplantation Sciences, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States. elias.nahel@mgh.harvard.edu
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Feb 18, 2023; 13(2): 44-57 Published online Feb 18, 2023. doi: 10.5500/wjt.v13.i2.44
Table 1 Characteristics of donors in the pre-direct-acting antivirals era and the post-direct-acting antivirals era
Characteristics
D-R-
D-R+
D+R-
D+R+
P value
n
Pre
116108
4646
550
2455
Post
46099
1443
1082
1303
Age (median [IQR])
Pre
40.0 [23.0, 51.0]
40.0 [24.0, 51.0]
41.0 [34.0, 46.0]
42.0 [33.0, 49.0]
< 0.001
Post
40.0 [27.0, 52.0]
42.0 [29.0, 52.0]
35.0 [29.0, 44.0]
32.0 [26.0, 39.0]
< 0.001
Gender = M (%)
Pre
69042 (59.5)
2762 (59.4)
380 (69.1)
1574 (64.1)
< 0.001
Post
28136 (61.0)
853 (59.1)
617 (57.0)
818 (62.8)
0.012
BMI (median [IQR])
Pre
25.6 [22.4, 29.7]
25.6 [22.3, 29.4]
24.8 [22.1, 28.0]
25.1 [22.3, 28.6]
< 0.001
Post
27.1 [23.4, 31.9]
27.5 [23.7, 32.2]
26.3 [23.3, 30.5]
25.6 [22.8, 29.4]
< 0.001
Race (%)
White
Pre
83490 (71.9)
3209 (69.1)
409 (74.4)
1824 (74.3)
< 0.001
African American
14085 (12.1)
698 (15.0)
91 (16.5)
341 (13.9)
Hispanic
14482 (12.5)
574 (12.4)
45 ( 8.2)
260 (10.6)
Other
4051 (3.5)
165 ( 3.6)
5 ( 0.9)
30 (1.2)
White
Post
31238 (67.8)
929 (64.4)
922 (85.2)
1103 (84.7)
< 0.001
African American
6325 (13.7)
273 (18.9)
44 (4.1)
58 (4.5)
Hispanic
6421 (13.9)
187 (13.0)
94 (8.7)
116 (8.9)
Other
2115 (4.6)
54 (3.7)
22 (2.0)
26 (2.0)
Cause of death (%)
Anoxia
Pre
19852 (17.1)
750 (16.1)
67 (12.2)
470 (19.1)
< 0.001
Cerebrovascular/stroke
44318 (38.2)
1800 (38.7)
196 (35.6)
985 (40.1)
Head trauma
48450 (41.7)
1926 (41.5)
281 (51.1)
960 (39.1)
Other
3488 (3.0)
170 (3.7)
6 (1.1)
40 (1.6)
Anoxia
Post
18056 (39.2)
574 (39.8)
779 (72.0)
882 (67.7)
< 0.001
Cerebrovascular/stroke
12337 (26.8)
397 (27.5)
109 (10.1)
127 (9.7)
Head trauma
14151 (30.7)
430 (29.8)
176 (16.3)
272 (20.9)
Other
1555 (3.4)
42 (2.9)
18 (1.7)
22 (1.7)
DCD = yes (%)
Pre
10101 (8.7)
368 (7.9)
11 (2.0)
105 (4.3)
< 0.001
Post
10519 (22.8)
329 (22.8)
151 (14.0)
128 (9.8)
< 0.001
SCR (median [IQR])
Pre
1.0 [0.7, 1.3]
1.0 [0.7, 1.3]
0.9 [0.7, 1.2]
0.9 [0.7, 1.1]
< 0.001
Post
0.9 [0.7, 1.4]
1.0 [0.7, 1.4]
0.9 [0.7, 1.3]
0.9 [0.7, 1.1]
< 0.001
History of diabetes = yes (%)
Pre
6712 (5.8)
254 (5.5)
14 (2.5)
95 (3.9)
< 0.001
Post
3616 (7.8)
123 (8.5)
41 (3.8)
30 (2.3)
< 0.001
History of hypertension = yes (%)
Pre
28967 (24.9)
1137 (24.5)
114 (20.7)
576 (23.5)
0.038
Post
13638 (29.6)
453 (31.4)
226 (20.9)
173 (13.3)
< 0.001
Smoking history = no (%)
Pre
78484 (67.6)
3039 (65.4)
234 (42.5)
1068 (43.5)
< 0.001
Post
36564 (79.3)
1154 (80.0)
723 (66.8)
953 (73.1)
< 0.001
Table 2 Characteristics of recipients in the pre-direct-acting antivirals era and the post-direct-acting antivirals era
Characteristics
D-R-
D-R+
D+R-
D+R+
P value
n
Pre
116108
4646
550
2455
Post
46099
1443
1082
1303
Age (median [IQR])
Pre
53.0 [42.0, 61.0]
51.0 [44.0, 58.0]
57.0 [47.0, 65.0]
53.0 [47.0, 59.0]
< 0.001
Post
55.0 [44.0, 64.0]
59.0 [52.0, 64.0]
60.0 [52.0, 67.0]
60.0 [55.5, 65.0]
< 0.001
Gender = M (%)
Pre
69448 (59.8)
3251 (70.0)
406 (73.8)
1995 (81.3)
< 0.001
Post
27135 (58.9)
994 (68.9)
739 (68.3)
1017 (78.1)
< 0.001
BMI (median [IQR])
Pre
26.8 [23.6, 30.9]
26.1 [23.0, 29.9]
26.5 [23.6, 29.4]
26.4 [23.3, 29.8]
< 0.001
Post
28.6 [24.9, 32.8]
27.8 [24.4, 31.6]
29.1 [25.7, 33.3]
27.8 [24.5, 31.5]
< 0.001
Race (%)
White
Pre
56376 (48.6)
1383 (29.8)
211 (38.4)
404 (16.5)
< 0.001
African American
34683 (29.9)
2447 (52.7)
290 (52.7)
1789 (72.9)
Hispanic
15940 (13.7)
517 (11.1)
27 (4.9)
201 (8.2)
Other
9109 (7.8)
299 (6.4)
22 (4.0)
61 (2.5)
White
Post
16501 (35.8)
334 (23.1)
494 (45.7)
267 (20.5)
< 0.001
African American
15762 (34.2)
784 (54.3)
392 (36.2)
855 (65.6)
Hispanic
9079 (19.7)
226 (15.7)
117 (10.8)
137 (10.5)
Other
4757 (10.3)
99 (6.9)
79 (7.3)
44 (3.4)
Insurance = nonprivate (%)
Pre
83051 (71.5)
3733 (80.3)
418 (76.0)
1831 (74.6)
< 0.001
Post
37085 (80.4)
1265 (87.7)
831 (76.8)
993 (76.2)
< 0.001
Education level (%)
High school
Pre
44906 (38.7)
1923 (41.4)
222 (40.4)
1195 (48.7)
< 0.001
Technical
22531 (19.4)
931 (20.0)
86 (15.6)
450 (18.3)
Post high school degree
18972 (16.3)
494 (10.6)
59 (10.7)
254 (10.3)
High school
Post
19085 (41.4)
741 (51.4)
403 (37.2)
680 (52.2)
< 0.001
Technical
11577 (25.1)
369 (25.6)
280 (25.9)
318 (24.4)
Post high school degree
10687 (23.2)
230 (15.9)
331 (30.6)
214 (16.4)
ESRD (%)
Diabetes
Pre
32208 (27.7)
1193 (25.7)
178 (32.4)
783 (31.9)
< 0.001
Hypertension
30368 (26.2)
1745 (37.6)
221 (40.2)
1108 (45.1)
Other
53532 (46.1)
1708 (36.8)
151 (27.5)
564 (23.0)
Diabetes
Post
14439 (31.3)
477 (33.1)
438 (40.5)
601 (46.1)
< 0.001
Hypertension
12513 (27.1)
543 (37.6)
270 (25.0)
444 (34.1)
Other
19147 (41.5)
423 (29.3)
374 (34.6)
258 (19.8)
Dialysis time, day, (median [IQR])
Pre
1143 [708, 1691]
1344 [889, 2164]
976 [580, 1388]
1118 [603, 1596]
< 0.001
Post
1661 [1043, 2373]
1999 [1364, 2988]
1257 [637, 1674]
1065 [593, 1661]
< 0.001
CPRA (median [IQR])
Pre
0.0 [0.0, 2.0]
0.0 [0.0, 2.0]
0.0 [0.0, 0.0]
0.0 [0.0, 0.0]
< 0.001
CPRA (mean [SD])
Post
19.3 (32.8)
20.5 (33.5)
9.4 (21.9)
9.3 (21.3)
< 0.001
PVD = yes (%)
Pre
5374 (4.6)
210 (4.5)
26 (4.7)
111 (4.5)
< 0.001
Post
4590 (10.0)
186 (12.9)
118 (10.9)
148 (11.4)
0.001
Diabetes = yes (%)
Pre
38827 (33.4)
1491 (32.1)
225 (40.9)
1014 (41.3)
< 0.001
Post
17213 (37.3)
583 (40.4)
521 (48.2)
714 (54.8)
< 0.001
Table 3 Characteristics of transplantation in the pre-direct-acting antivirals era and the post-direct-acting antivirals era
Characteristics
D-R-
D-R+
D+R-
D+R+
P value
n
Pre
116108
4646
550
2455
Post
46099
1443
1082
1303
TX year (median [IQR])
Pre
2005 [2000, 2010]
2004 [1999, 2009]
2001 [1997, 2007]
2006 [2001, 2010]
< 0.001
Post
2016 [2015, 2018]
2016 [2015, 2018]
2018 [2017, 2018]
2016 [2015, 2017]
< 0.001
Region (%)
1
Pre
4694 (4.0)
167 (3.6)
11 (2.0)
74 (3.0)
< 0.001
2
14123 (12.2)
661 (14.2)
112 (20.4)
823 (33.5)
3
17507 (15.1)
704 (15.2)
64 (11.6)
235 (9.6)
4
10816 (9.3)
414 (8.9)
29 (5.3)
136 (5.5)
5
17680 (15.2)
655 (14.1)
63 (11.5)
260 (10.6)
6
4356 (3.8)
156 (3.4)
6 (1.1)
7 (0.3)
7
9360 (8.1)
403 (8.7)
54 (9.8)
137 (5.6)
8
7738 (6.7)
252 (5.4)
23 (4.2)
55 (2.2)
9
7150 (6.2)
355 (7.6)
29 (5.3)
222 (9.0)
10
10186 (8.8)
457 (9.8)
104 (18.9)
192 (7.8)
11
12498 (10.8)
422 (9.1)
55 (10.0)
314 (12.8)
1
Post
1601 (3.5)
62 (4.3)
35 (3.2)
65 (5.0)
< 0.001
2
5404 (11.7)
182 (12.6)
151 (14.0)
349 (26.8)
3
6590 (14.3)
221 (15.3)
181 (16.7)
150 (11.5)
4
4526 (9.8)
173 (12.0)
45 (4.2)
67 (5.1)
5
8107 (17.6)
238 (16.5)
101 (9.3)
144 (11.1)
6
1911 (4.1)
55 (3.8)
13 (1.2)
6 (0.5)
7
3192 (6.9)
110 (7.6)
37 (3.4)
45 (3.5)
8
3130 (6.8)
86 (6.0)
5 (0.5)
44 (3.4)
9
3057 (6.6)
85 (5.9)
125 (11.6)
174 (13.4)
10
3507 (7.6)
79 (5.5)
195 (18.0)
84 (6.4)
11
5074 (11.0)
152 (10.5)
194 (17.9)
175 (13.4)
Shared (%)
Local
Pre
85197 (73.4)
3464 (74.6)
223 (40.5)
931 (37.9)
< 0.001
Regional
9559 (8.2)
377 (8.1)
124 (22.5)
591 (24.1)
National
21352 (18.4)
805 (17.3)
203 (36.9)
933 (38.0)
Local
Post
35095 (76.1)
1115 (77.3)
337 (31.1)
379 (29.1)
< 0.001
Regional
5349 (11.6)
157 (10.9)
345 (31.9)
348 (26.7)
National
5655 (12.3)
171 (11.9)
400 (37.0)
576 (44.2)
CIT (median [IQR])
Pre
18.0 [13.0, 23.1]
18.0 [13.0, 23.5]
20.0 [16.0, 26.0]
19.0 [15.0, 25.0]
< 0.001
Post
16.7 [11.4, 22.6]
16.5 [11.0, 22.0]
18.4 [13.1, 23.8]
18.0 [12.3, 23.5]
< 0.001
HLA mismatch = 4-6 (%)
Pre
76253 (65.7)
3238 (69.7)
452 (82.2)
2151 (87.6)
< 0.001
Post
35126 (76.2)
1170 (81.1)
894 (82.6)
1154 (88.6)
< 0.001
DGF = yes (%)
Pre
28919 (24.9)
1440 (31.0)
139 (25.3)
756 (30.8)
< 0.001
Post
13468 (29.2)
496 (34.4)
222 (20.5)
284 (21.8)
< 0.001
Table 4 Patient survival and death-censored graft survival at 3 years in the pre-direct-acting antivirals era and the post-direct-acting antivirals era
Cohorts in comparison (%)
D-R+
D+R+
D-R-
D+R-
Absolute risk difference
Crude
Patient survival
Pre
86.7 (85.8, 87.7)
84.8 (83.4, 86.3)
89.6 (89.5, 89.8)
73.1 (69.4, 76.9)
-
Post
88.1 (85.7, 90.5)
89.8 (87.7, 92)
91 (90.6, 91.3)
86.1 (77.6, 95.6)
-
Death-censored graft survival
Pre
84.2 (83.1, 85.3)
82 (80.4, 83.6)
88.8 (88.6, 89)
80.1 (76.6, 83.7)
-
Post
92.4 (90.6, 94.2)
94.2 (92.5, 96)
92.5 (92.2, 92.8)
92.6 (87.3, 98.3)
-
D+ vs D- in R+
Patient survival
Pre
86.3 (84.4, 88.2)
84.8 (82.8, 86.8)
-
-
3.3 (1.8, 4.7)
Post
90.2 (85.5, 95)
88.7 (84, 93.7)
-
-
2.7 (-2.9, 8.1)
Death-censored graft survival
Pre
83.6 (81.5, 85.8)
81.6 (79.4, 83.9)
-
-
3.1 (1.2, 5)
Post
90.1 (85.5, 94.9)
92 (87.9, 96.3)
-
-
0.4 (-5, 6.1)
D+ vs D- in R-
Patient survival
Pre
-
-
85.3 (82.3, 88.4)
73.5 (69.8, 77.4)
8 (5.2, 10.9)
Post
-
-
89.1 (83.6, 94.9)
88.6 (81.6, 96.2)
-0.3 (-5.9, 6.1)
Death-censored graft survival
Pre
-
-
86.9 (83.9, 89.9)
80.4 (76.8, 84.1)
7.4 (4.3, 10.5)
Post
-
-
92.2 (87.8, 96.8)
93.8 (88.5, 99.4)
-2.3 (-7.4, 2.1)
R+ vs R- in D+
Patient survival
Pre
-
80.9 (77.3, 84.6)
-
76.7 (72.8, 80.7)
0.1 (-2.9, 3.1)
Post
-
88.4 (84.3, 92.8)
-
85.1 (75.4, 96)
1.1 (-6.1, 7)
Death-censored graft survival
Pre
-
79.4 (75.5, 83.5)
-
80.6 (76.9, 84.6)
1.2 (-2.5, 4.9)
Post
-
93 (89.6, 96.5)
-
92.3 (86.2, 98.8)
0.7 (-5, 5.4)
R+ vs R- in D-
Patient survival
Pre
86.7 (85.8, 87.7)
-
88.7 (87.8, 89.6)
-
2.6 (1.9, 3.2)
Post
88.1 (85.7, 90.5)
-
89.5 (87.3, 91.8)
-
-0.5 (-3.3, 2.2)
Death-censored graft survival
Pre
84.2 (83.1, 85.3)
-
86.5 (85.5, 87.5)
-
3.5 (2.6, 4.4)
Post
92.4 (90.6, 94.2)
-
92.1 (90.2, 94.1)
-
-0.2 (-2.4, 2)
D+R+ vs D-R-
Patient survival
Pre
-
85 (83.4, 86.5)
89 (87.7, 90.4)
-
5.3 (4.3, 6.4)
Post
-
88.4 (85.5, 91.4)
91.8 (89.2, 94.4)
-
3.3 (0, 6.7)
Death-censored graft survival
Pre
-
82.7 (81, 84.4)
87.8 (86.4, 89.2)
-
7.1 (5.7, 8.5)
Post
-
93.3 (90.9, 95.8)
93.3 (90.9, 95.8)
-
1.7 (-1.4, 4.5)
D+R- vs D-R+
Patient survival
Pre
85.4 (82.1, 88.8)
-
-
75.6 (71.6, 79.7)
5.4 (2.6, 8.6)
Post
88.7 (81.8, 96.3)
-
-
91.5 (85, 98.6)
3.2 (-5.9, 11.6)
Death-censored graft survival
Pre
84.5 (81.1, 88.1)
-
-
81.1 (77.3, 85.1)
4.8 (1.4, 8.2)
Post
94.4 (89.3, 99.7)
-
-
93.3 (87.4, 99.5)
2.5 (-3.6, 10)
Citation: Yuan Q, Hong S, Leya G, Roth E, Tsoulfas G, Williams W, Madsen JC, Elias N. Analysis of the effects of donor and recipient hepatitis C infection on kidney transplant outcomes in the United States. World J Transplant 2023; 13(2): 44-57