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Hundreds of Donor Kidneys Tossed Away Each Year
Date:4/1/2010

But organs infected with hepatitis C are fine for patients with the disease, study finds

THURSDAY, April 1 (HealthDay News) -- Every year, hundreds of kidneys are thrown out because they may be infected with hepatitis C, but they could help many hepatitis C-infected patients waiting for a transplant, Johns Hopkins researchers report.

In fact, since 1995, more than 3,500 kidneys infected with hepatitis C were thrown away. Using hepatitis C-infected kidneys has been controversial, in part due to a 1 percent difference in one-year survival and a 2 percent difference in three-year survival among these patients, the researchers noted.

"Patients with hepatitis C who have kidney failure could very much benefit from these kidneys from hepatitis C-positive donors," said lead researcher Dr. Dorry L. Segev, an associate professor of surgery at Johns Hopkins.

Of the more than 3,500 kidneys thrown away, more than 1,000 came from "what would be considered perfect donors," he said.

The small risk of a hepatitis C-positive patient dying after receiving a hepatitis C-infected kidney is offset by the risk of waiting for a hepatitis C-free kidney, Segev added.

The report is published in the March 31 online edition of the American Journal of Transplantation.

For the study, Segev's team looked at data on 93,825 kidney donors from 1995 to 2009. The researchers found that kidneys infected with hepatitis C were 2.5 times more likely to be discarded than kidneys without the infection.

Since 1995, 3,562 hepatitis C-infected kidneys have been lost, the researchers noted. Many of these hepatitis C-infected kidneys would have been perfectly suited to people already infected with the disease who are on dialysis and the kidney transplant list, Segev said.

Segev's group found that one-third of the transplant centers in the United States do not use any kidneys infected with hepatitis C for hepatitis C-infected patients. On the other hand, 13 percent of transplant centers transplanted more than 50 percent of their hepatitis C-infected patients with kidneys infected with the disease.

During the study period, some 4,800 hepatitis C patients got hepatitis C-negative kidneys. "Using hepatitis C-positive kidneys in people who are infected with the virus could help those with hepatitis C and also expand the organ supply for everyone," Segev said.

Among patients with kidney failure, about 12 percent are infected with hepatitis C. These patients are at increased risk of death on dialysis compared with those without the virus, the researchers said.

In addition, these patients who are waiting for a non-infected kidney wait longer for a transplant -- more than a year longer than other patients, increasing their risk of dying 10 percent to 15 percent during the extra year of waiting, Segev noted.

Segev pointed out that some people think hepatitis C-infected kidneys can be successfully transplanted into patients without hepatitis C. "We are not advocating that," he said.

"We are strictly advocating the fact that there are thousands of perfectly good hepatitis C kidneys that are thrown away, while hepatitis C-positive recipients are sitting there on the waiting list incurring a huge risk of dying while waiting for a different organ," Segev said.

Dr. David Roth, the Wm. Way Anderson Professor of Nephrology and medical director of renal transplantation at the University of Miami Miller School of Medicine, said the types of kidneys used for transplant have been expanded.

"In this day and age we look really hard at different types of groups of organ donors, because there are so many people on the list that we have extended the boundaries of what might have been considered an acceptable or unacceptable kidney," Roth said.

There are patients infected with hepatitis C that "could benefit in years of life and quality of life by getting off of dialysis and receiving a kidney from such a donor," Roth said.

More information

For more information on kidney transplantation, visit the U.S. National Institute of Diabetes, Digestive and Kidney Diseases.



SOURCES: Dorry L. Segev, M.D., Ph.D., associate professor, surgery, Johns Hopkins University School of Medicine, Baltimore; David Roth, M.D., Wm. Way Anderson Professor of Nephrology, medical director, renal transplantation, University of Miami Miller School of Medicine; March 31, 2010, American Journal of Transplantation, online


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