Donor Characteristics and Regional Differences in the Utilization of HCV-Positive Donors in Liver Transplantation

Abstract

IMPORTANCEIncreased utilization of hepatitis C virus (HCV)-positive liver allografts for liver transplant (LT) has been endorsed as one of several ways to combat national organ shortages. However, HCV-positive donors remain poorly characterized, and Organ Procurement and Transplantation Network regional differences in the utilization of HCV-positive liver allografts are unclear. OBJECTIVE To characterize HCV-positive donors and the allografts that come from them. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, the Scientific Registry of Transplant Recipients database was queried for all donors who underwent HCV testing from June 2015 to December 2018. Clinical and allograft characteristics were evaluated, and utilization across the United States was studied. Patients with positive or negative results for HCV antibody (Ab) and HCV nucleic acid amplification testing (NAT) were included in this study. Donors utilized for living donor transplant and pediatric (age <18 years) recipients were excluded.

Varying Utilization Rates but Superior Outcomes in Liver Transplantation From Hepatitis C−positive Donors in the United States: An Analysis of the OPTN/UNOS Database

“…8,15 Da et al reported that >30% of the HCV-positive donor grafts in OPTN regions 4, 6, 7, and 8 were being used in nearby regions, suggesting that HCV-positive liver grafts were being passed up locally. 8 This results underscores the significant impact of each center's individual practice on the utilization of HCV-positive donors. Currently, there are no standardized rules from UNOS regarding the utilization of livers from HCV-positive donors.…”

“…HCV-positive donors are more likely to be younger, have fewer comorbidities such as obesity, diabetes, and hypertension. 5,8 There are several possible explanations for these differences. HCV-positive donors are much more likely to have died of drug overdoses compared to those without HCV infection.…”

“…HCV-positive donors are much more likely to have died of drug overdoses compared to those without HCV infection. 8 The increased use of injection drugs has resulted in increased risk of HCV transmission among at-risk populations, mainly among young persons. 12 These otherwise healthy donors have a favorable donor risk index 13 that can afford excellent graft longevity.…”

An Update on Usage of High-Risk Donors in Liver Transplantation

“…An estimated 300 to 500 additional liver allografts from HCV positive donors could be utilized for transplantation to maximize liver donor pool [ 14 ]. Increasing intra venous opioid consumption in society has not only led to a greater incidence of HCV but also overdose related deaths [ 15 ]. The US opioid epidemic continues to increase, and deaths from opioid misuse increased threefold between 1999 and 2014 [ 16 ].…”

Liver Outcome in Renal Transplant Recipients Who Acquired Hepatitis C Infection From an Infected Graft: Study Based on Liver Biopsy Findings

“…3,4 In addition, donors who die from opioid overdoses and have HCV infection tend to be younger and less likely to have hypertension, diabetes, and other chronic comorbidities and were more likely to be White. [5][6][7] DAAs are highly effective treatment with cure rates of 95%-99% across different genotypes and favorable side-effect profiles. [8][9][10][11] Effective HCV treatments enable kidney transplantation (KT) of HCV-infected grafts to non-HCV-infected recipients.…”