Should hepatitits-C virus antibody-positive donors be excluded from kidney donation?

In organ transplantation, virus transmitted by the donor is associated with a higher risk of severe primary infection after transplantation in the seronegative recipient. In this study, the risk of hepatitis-C virus (HCV) transmission by the kidney was determined, and the morbidity in the recipient assessed. Serum samples from all kidney donors of our Transplantation Unit between 1983 and 1988 were screened for antibodies to anti-HCV by first enzyme-linked immunosorbent assay (Ortho ELISA) and positive samples were confirmed by a second-generation ELISA and the CHIRON RIBA HCV test. Of the 164 kidney donors whose sera were available, five were positive (3%) and all of them were positive with the RIBA test. Liver function was normal in the five donors. Seven recipients received a renal transplant from the anti-HCV-positive donors. Two patients had a follow-up too short to draw any conclusions. Two patients remained anti-HCV-negative up to 36 and 48 months, respectively, but one of them had chronic hepatitis. One patient was anti-HCV-positive before transplantation and remained positive over the 4-year follow-up. The two last patients seroconverted and acute hepatitis occurred at 16 and 101 days after transplantation, respectively. In both cases, no peroperative or postoperative transfusion was given and no other cause of hepatitis could be determined. A cirrhotic evolution was observed within 15 and 36 months in both cases. Thus HCV can be transmitted by a kidney transplant and cadaveric donors positive for anti-HCV antibodies should be excluded from kidney donation.