Transplantation of organs from hepatitis C virus (HCV)-antibody (Ab) and -nucleic acid test (NAT) positive donors into HCV-negative recipients has been proposed to expand the donor pool and shorten waiting times. Data on early single-center outcomes are lacking. Nineteen liver (LT, including seven simultaneous liver-kidney [SLKT]) and 17 kidney transplant (KT) recipients received organs from HCV (+) donors; of these, 13 were HCV NAT (+) in each group. All patients who received organs from HCV NAT (+) donors developed HCV viremia post-transplant except for 2 KT recipients. Patients were treated with a variety of direct-acting antiviral regimens, with high rates of sustained virologic response among those with at least 12 weeks of follow-up past the end of treatment: 12/13 (92%) and 8/8 (100%) among LT/SLKT, and KT recipients. Median time to treatment start was 42 days (interquartile range[IQR] 35-118 days) and 40 days (IQR 26-73) post-LT/SLKT and KT, respectively. One death occurred in a SLKT recipient unrelated to HCV or its treatment. There was no significant increase in rejection, proteinuria, or changes in immunosuppression in any group. Organs from HCV-viremic donors can be utilized for HCV-uninfected recipients with good short-term outcomes.
K E Y W O R D Shepatitis C virus, hepatitis C-positive donors, kidney transplantation, liver transplantation 2 of 11 | CRISMALE Et AL. unacceptable due to the low efficacy and high risks associated with IFN-based therapy post-transplantation. Such organs were therefore reserved for transplantation into those already with HCV infection. Even among these patients, the persistence of HCV infection post-transplantation was associated with poor outcomes and led to worse post-transplant survival. 4,5 However, the advent of highly effective direct-acting antiviral therapy (DAAs) has led to post-transplantation HCV cure rates exceeding 95%, and with it, a negation of the ill effects of HCV previously seen in both LT and KT recipients. 6,7 A number of clinical trials, along with data from the HCV-TARGET cohort, have demonstrated the efficacy and safety of the use of these agents in the post-transplant setting. 8,9 In the HCV-TARGET cohort, adverse events leading to treatment discontinuation were uncommon, affecting only 1.6%. 8 Newer agents, including glecaprevir/ pibrentasvir (GLE/PIB), have similarly been shown to be safe and efficacious. 10 Indeed, recently published data derived from the Scientific
Registry of Transplant Recipients (SRTR) suggest equivalent 1-and3-year survival among HCV-infected patients undergoing LT. 6 In the United States, the potential pool of HCV-positive organs is growing, largely due to a rising incidence of HCV in persons who inject drugs. There is significant geographic and demographic overlap between the opioid epidemic and incident HCV infection. 11 Data suggest that up to 52% of HCV-infected individuals are concentrated in 9 US states, the majority of which have a significant burden of patients suffering with opioid addiction. 12 Drug overdose...
