Changes in practice and perception of hepatitis C and liver transplantation: Results of a national survey

Abstract

With new practice guidelines, it is important to understand how liver transplant (LT) centers have incorporated direct-acting antivirals (DAAs) into the management of hepatitis C virus-infected (HCV+) candidates and recipients. To explore how DAAs have affected LT centers’ willingness to treat HCV+ candidates and recipients and to use HCV+ donors, we surveyed high volume US LT centers (11/2014–12/2015) regarding practices for HCV+ candidates, recipients, and donors, before vs. after DAAs. We used the Scientific Registry of Transplant Recipients to compare centers’ number of LTs, HCV+ recipients, and HCV+ donors in the years before (1/1/2012–12/31/2013) and after (1/1/2016–12/31/2017) survey administration. Of 80 centers contacted, 57 (71%) responded, representing 69% of the total volume of LTs in 2013. After DAAs, most centers increased treating candidates with low (≤15) model for end-stage liver disease (MELD) (85.2%), intermediate/high (>15) MELD (92.6%), and hepatocellular carcinoma (79.6%). There was consensus to treat low MELD candidates (90.7% “most of the time/always”), but less certainty for intermediate/high MELD candidates (27.8% “sometimes”). Universal post-LT HCV treatment increased (7.4% vs. 57.4%). After DAAs, 42.6% were more willing to use HCV+ donors for HCV+ candidates, and 38.9% were willing to consider using HCV+ donors for HCV- candidates. Overall, with DAAs, centers were more willing to treat HCV+ candidates and recipients and to use HCV+ donors; recent recommendations may help to guide treatment decisions for intermediate/high MELD candidates.

Liver transplantation for hepatitis C virus (HCV) non-viremic recipients with HCV viremic donors

“…4,7,8 The aim of our study was to summarize the posttransplant outcomes after donor-derived HCV infection in non-viremic liver transplant recipients at our institution. 4,7,8 The aim of our study was to summarize the posttransplant outcomes after donor-derived HCV infection in non-viremic liver transplant recipients at our institution.…”

“…4,7,8 The aim of our study was to summarize the posttransplant outcomes after donor-derived HCV infection in non-viremic liver transplant recipients at our institution. 1 In the context of this organ shortage, it is essential to make the best use of all transplantable organs.…”

“…6In the setting of the ongoing organ shortage, the opioid epidemic, and the advent of DAA therapy, more HCV-infected donor organs are being utilized to expand the donor pool, and non-viremic patients are being given the option to accept these grafts in some centers, including ours. 4,7,8 The aim of our study was to summarize the posttransplant outcomes after donor-derived HCV infection in non-viremic liver transplant recipients at our institution.…”

Center-level trends in utilization of HCV-exposed donors for HCV-uninfected kidney and liver transplant recipients in the United States

“…The use of HCV Ab+ donor organs for HCV Ab+ recipients has grown dramatically, particularly since curative interferon-free direct-acting antiviral (DAA) therapies became available. 1,[6][7][8][9][10][11][12][13][14] The risk of HCV transmission, which depends on the presence or absence of viremia, is an important consideration when using HCV Ab+ donors for HCV-recipients. 2,3 However, despite DAA availability and increased use among HCV Ab+ recipients, high-quality HCV Ab+ donor organs remain underutilized.…”

“…[1][2][3][4][5] In light of these factors and the persistent organ shortage, transplant centers have reported increasing willingness to use HCV Ab+ donors for HCV-uninfected (HCV-) recipients, and there is some evidence that this practice is growing. 1,[6][7][8][9][10][11][12][13][14] The risk of HCV transmission, which depends on the presence or absence of viremia, is an important consideration when using HCV Ab+ donors for HCV-recipients. 15 One study using 32 HCV Ab+ aviremic kidney donors for HCV-recipients found no subsequent HCV viremia among recipients, whereas another study using 26 HCV Ab+ aviremic liver donors for HCV-recipients found HCV transmission in four (16%) patients.…”