Crisis Point: Stigma Hinders Adoption of Hepatitis C-Positive Donor Kidneys

This is Crisis Point.

Our mini-docuseries has returned, taking a comprehensive look at public health crises affecting the United States today, with global implications tomorrow. If the crisis point is the moment where a crisis will worsen or begin to get better, the question remains: where are we now?

The Impact of Stigma on Uptake of HCV-Positive Donor Kidneys

This episode addresses the ongoing organ shortage crisis amid a growing national transplant waitlist with more than 100,000 people currently seeking a transplant – of these patients, nearly 90,000 are waiting for a new kidney. The advent of direct-acting antiviral (DAA) therapy has transformed clinicians’ ability to treat and cure hepatitis C virus (HCV), a byproduct of these advances has been the ability for the safe and effective use of HCV-positive donor kidneys in non-infected transplant recipients.

Published in 2020, the MYTHIC trial set the stage for using HCV-positive donor kidneys and is widely referenced when discussing their safety and efficacy. Preliminary results for 30 kidney transplants from HCV-viremic donors into HCV-negative recipients showed a 100% cure rate, defined as undetectable plasma HCV RNA 12 weeks after completion of an 8-week course of glecaprevir/pibrentasvir initiated in the early post-transplant period. A follow-up study published in 2021 detailed 1-year findings confirmed this cure rate and further detailed the excellent survival and graft function, which occurred with no clinically significant liver disease or HCV-related kidney injury. Though there is a mounting body of evidence supporting the use of these “increased-risk” organs to help combat the organ shortage, a stigma surrounding HCV persists and hinders uptake of these organs.

For further insight, we gathered perspectives from across the spectrum of the decision-making process for the transplantation of an HCV-positive donor kidney: the hepatologist, the nephrologist, and, at the center of it all, the patient undergoing the transplant. The trio discusses patient perception of this topic and what clinicians can do to help ease transplant recipients’ potential hesitancy about accepting an HCV-positive donor kidney, with additional patient perspective about her experience receiving an HCV donor kidney and the recovery process afterward.

Brief descriptions of the speakers featured in this project are provided below:

• Nancy Reau, MD, associate director of solid organ transplantation and section chief of hepatology at Rush University Medical Center
• Joseph Vassalotti, MD, associate clinical professor of medicine in the division of nephrology at Ichan School of Medicine at Mount Sinai and chief medical officer of the National Kidney Foundation
• Kirsten Uzzardo, 3-time kidney transplant recipient, the most recent of which was with an HCV-positive donor kidney

For more video content, visit our Crisis Point page to see other episodes on improving health equity in eye care, disparities in cardiovascular health, insulin access in the United States, physician burnout across healthcare, and the ongoing obesity crisis.

References:

1. ^{Health Resources & Services Administration. Organ Donation Statistics. Learn About Donation. February 2024. Accessed March 13, 2024. https://www.organdonor.gov/learn/organ-donation-statistics}
2. ^{Jones JM, Kracalik I, Levi ME, et al. Assessing Solid Organ Donors and Monitoring Transplant Recipients for Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Infection — U.S. Public Health Service Guideline, 2020. MMWR Recomm Rep 2020;69(No. RR-4):1–16. doi:http://dx.doi.org/10.15585/mmwr.rr6904a1}
3. ^{Sise ME, Goldberg DS, Schaubel DE, et al. One-Year Outcomes of the Multi-Center StudY to Transplant Hepatitis C-InfeCted kidneys (MYTHIC) Trial. Kidney Int Rep. 2021;7(2):241-250. Published 2021 Dec 1. doi:10.1016/j.ekir.2021.11.022}
4. ^{Sise ME, Goldberg DS, Kort JJ, et al. Multicenter Study to Transplant Hepatitis C-Infected Kidneys (MYTHIC): An Open-Label Study of Combined Glecaprevir and Pibrentasvir to Treat Recipients of Transplanted Kidneys from Deceased Donors with Hepatitis C Virus Infection. J Am Soc Nephrol. 2020;31(11):2678-2687. doi:10.1681/ASN.2020050686}
5. ^{World Health Organization. Hepatitis C. Newsroom. July 18, 2023. Accessed March 13, 2024. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c?gad_source=1&gclid=Cj0KCQjwncWvBhD_ARIsAEb2HW9K-AXN4ghg6q65N2vU0Qlapc8CiyklKK4tbr7A331c7Zw_pXSG1lsaAkB9EALw_wcB}
6. ^{US Centers for Disease Control and Prevention. Hepatitis C Questions and Answers for the Public. Viral Hepatitis. October 31, 2023. Accessed March 13, 2024. https://www.cdc.gov/hepatitis/hcv/cfaq.htm#overview}
7. ^{Watson, S. Mental Health Spotlight: Managing the Stigma of Hepatitis C. Healthline. April 21, 2022. Accessed March 13, 2024. https://www.healthline.com/health/hepatitis-c/managing-the-stigma-of-hepatitis-c}