Race, Risk, and Willingness of End-stage Renal Disease Patients Without Hepatitis C (HCV) to Accept an HCV-infected Kidney Transplant.

Background: Despite effective antiviral treatment, hundreds of kidneys from deceased donors with hepatitis C virus (HCV) are discarded annually. Little is known about the determinants of willingness to accept HCV-infected kidneys among HCV-negative patients. Methods: At 2 centers, 189 patients undergoing initial or reevaluation for transplant made 12 hypothetical decisions about accepting HCV-infected kidneys in which we systematically varied expected HCV cure rate, allograft quality and wait-time for an uninfected kidney. Results: Only 29% of participants would accept an HCV-infected kidney under all scenarios, while 53% accepted some offers and rejected others, and 18% rejected all HCV-infected kidneys. Higher cure rate (OR 3.49, 95% CI 2.33-5.24 for 95% vs. 75% probability of HCV cure), younger donor (OR 2.34, 95% CI 1.91-2.88 for a 20-year-old vs. a 60-year-old hypertensive donor), and longer wait for an uninfected kidney (OR 1.43, 95% CI 1.22-1.67 for 5 vs. 2 years) were associated with greater willingness to accept an HCV-infected kidney. Black race modified the effect of HCV cure rate, such that willingness to accept a kidney increased less for blacks vs. whites as the cure rate improved. Patients >60 years and prior kidney recipients showed greater willingness to accept an HCV-infected organ. Conclusions: Most patients will consider an HCV-infected kidney in some situations. Future trials using HCV-infected kidneys may enhance enrollment by targeting older patients and prior transplant recipients, but centers should anticipate that black patients' acceptance of HCV-infected kidneys will be reduced compared to white patients. Copyright (C) 2018 Wolters Kluwer Health, Inc. All rights reserved.

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