Kidney transplant with a kidney infected with hepatitis C virus, followed by treatment for the hepatitis C, was effective and reduced costs compared with transplant with an uninfected kidney after hepatitis C treatment, according to new research published in Annals of Internal Medicine.
“Between 10% to 15% of U.S. patients receiving dialysis are seropositive for [HCV],” the researchers wrote. “Some of these patients are willing to accept HCV-infected kidneys from deceased donors in part because wait times for such kidneys are shorter than those for HCV-uninfected kidneys.”
Researchers compared the quality-adjusted life years (QALYs) and cost of kidney transplants among patients with HCV who received an HCV-infected kidney, then HCV treatment, and patients who received HCV treatment, then an HCV-uninfected kidney.
They found that transplanting an HCV-infected kidney decreased QALYs due to increased lifetime probability of death from end-stage liver disease by 5%, compared with an increase of 3.4% for receiving an HCV-uninfected kidney. Transplant of an HCV-uninfected kidney also led to a decrease in QALYs related to chronic kidney disease; however, there was a 34.5% increase in death from chronic kidney disease among recipients of HCV-uninfected kidneys, vs. a 29% increase among recipients of HCV-infected kidneys. Researchers noted that this difference was due to increased duration of dialysis while waiting for an uninfected kidney.
The researchers also found that transplant of an HCV-infected kidney followed by HCV treatment was less costly than transplant of an HCV-uninfected kidney, due to wait times. An average patient gained 0.5 QALY at a lifetime cost savings of $41,591, when receiving an HCV-infected kidney.
“In an era of increasing success for kidney transplants and demand that far outstrips supply, deferring antiviral therapy until after transplant of HCV-infected kidneys, when available, should be both cost-saving and effective,” the researchers wrote. – by Jake Scott
Eckman reports grants from Merck during the conduct of the study. Please see the study for all authors’ relevant financial disclosures.