Balancing the risk and rewards of utilizing organs from hepatitis C viremic donors

Abstract

Purpose of review: Because of long waitlist times and high waitlist morbidity and mortality, strategies to increase utilization of Hepatitis C viremic deceased donor organs are under investigation in kidney, liver, heart and lung transplantation. Recent findings: Direct-acting antiviral medications for Hepatitis C virus infection have high cure rates and are well tolerated. Small, single-center trials in kidney and heart transplant recipients have demonstrated that with early post-transplant direct-acting antiviral therapy, 100% of uninfected recipients of Hepatitis C viremic organs have been cured of infection after transplantation.

Clinician and patient attitudes toward use of organs from hepatitis C viremic donors and their impact on acceptance: A contemporary review

“…Although studies regarding cure rate of HCV infection in the post‐transplant population have demonstrated uniform cure rates of 100%, 6,7 these studies are limited by their small volume. However, these rates are comparable to the 98–100% cure rates observed with DAAs in the general population 8 …”

“…However, these rates are comparable to the 98-100% cure rates observed with DAAs in the general population. 8 A common theme that emerged in most studies was lack of knowledge and concern regarding curability of HCV infection, mentioned by both patients and providers. Although most patients were aware of HCV and its sequelae, Couri et al found that only 60% were aware of whether the disease was curable.…”

Transplantation of Organs from Hepatitis C Virus-Positive Donors under Direct-Acting Antiviral Regimens

“…With the discussion above, it is now possible for patients who are HCV-negative to receive grafts from donors with Hepatitis C virus with proper management before transplantation, and adequate administration of DAA treatment upon transplantation [44]. In applying DAA treatment regimens to improve the viability of HCV-positive organs, there is usually no time to carry out HCV genotyping because of the time pressure associated with organ transplants, and the logistical technicalities [44]. To ease this process, pangenotypic measures are employed, which will cover all HCV-positive organs [44].…”

“…In applying DAA treatment regimens to improve the viability of HCV-positive organs, there is usually no time to carry out HCV genotyping because of the time pressure associated with organ transplants, and the logistical technicalities [44]. To ease this process, pangenotypic measures are employed, which will cover all HCV-positive organs [44]. Several regimens have been approved for use over the years.…”

“…The combination of sofosbuvir and velapatasvir has proved to be as effective as the combination of sofosbuvir and ledipasvir, with the benefit of treating all genotypes. As it stands, it is the recommended treatment for patients who are not getting transplants with close to perfect outcomes [44]. In 2017, the treatment regimen of glecaprevir and pibrentasvir was the only treatment that had been approved for use with patients who have severe kidney failure or who are undergoing dialysis [45].…”