Hepatitis C positive organ transplantation to negative recipients at a multiorgan Canadian transplant centre: ready for prime time

Abstract

Background Transplantation offers the best survival for patients with end stage organ disease. Transplant of hepatitis C virus (HCV) nucleic acid test (NAT) positive organs into negative recipients is a novel strategy that can expand the donor pool. We aim to evaluate our centre’s experience. Methods We preformed a retrospective review of anti-HCV NAT positive and negative organs into negative recipients transplanted over 27 months. Primary outcome was the success rate of eradication of HCV post-transplant. Secondary outcomes were rate of transmission of HCV, treatment adverse events, and graft failure. Results 33 anti-HCV positive organs were transplanted into negative recipients. 22 (66.7%) were NAT positive. Median recipients age was 49 years (interquartile range [IQR] 44.5–62.0) with the majority being males (57.6%). NAT positive organ transplantations included 16 kidneys, 3 livers, 1 kidney-pancreas, 1 liver-kidney, and 1 heart. The most common HCV genotype was 1a (59.1%). The median time to initiating therapy was 41.5 days. SVR12 was 100% in patients who finished therapy. There were no adverse events with therapy and no graft failure. Conclusions Anti-HCV NAT positive organ transplantation into negative recipients is safe with excellent eradication rates and no significant adverse events or graft failure. This would expand donor pool to close the gap between supply and demand.

A systematic review of direct acting antiviral therapies in hepatitis C virus‐negative liver transplant recipients of hepatitis C‐viremic donors

“…Details of the DAA regimens utilized in the liver transplant population were reported for 231 liver alone or simultaneous liver-kidney transplant recipients within the 16 studies reviewed (Table 2). [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] The majority of patients were treated with pangenotypic DAA Society of America (IDSA) HCV treatment guidelines, as these examples demonstrate. 32 For example, in one study, two patients were treated with LDV/SOF plus ribavirin based on insurance coverage.…”

“…19,27,29 Given that all of the currently available pangenotypic DAA agents have similar characteristics and are highly effective for the treatment of donor-derived HCV infection after liver transplant, DAA selection appears to be primarily dependent upon payor preference. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]…”

“…to 118 days after transplant (Table 2). [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] Four studies reported some or all patients initiating DAAs inpatient prior to discharge from their index transplant hospitalization. 19,21,25,27 Only one prospective, single-center study was identified in which pre-emptive DAA treatment, initiation of therapy prior to known development of viremia, was started in 9 recipients of HCV-viremic liver allografts with GLE/PIB within 5 days of transplant.…”

“…Despite variation in time to DAA initiation among studies, this did not appear to impact the rate of achieving SVR. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] The potential complications of delaying DAA initiation such as glomerulonephritis (GN), graft-versus-host disease (GVHD), post-transplant lymphoproliferative disorder (PTLD), and HCV transmission to others are discussed elsewhere in this review.…”

A brief history of liver transplantation and transplant anesthesia

“…In addition, in relation to increasing the size of the donor pool, the introduction of therapy to cure hepatitis C means that hepatic grafts from hepatitis C–infected donors can now be used [ 52 ].…”