Should organs from hepatitis C‐positive donors be used in hepatitis C‐negative recipients for liver transplantation?

Abstract

Given the scarcity of donated organs and the frequency of death on the waiting list, strategies that could improve the available supply of high-quality liver grafts are much needed. Direct-acting antiviral agent (DAA) regimens have proved to be highly effective to treat hepatitis C virus (HCV), even in the setting of posttransplantation. The question arises as to whether transplant communities should consider the utilization of HCV-positive donors into HCV-negative recipients. This review summarizes risk of transmission, treatment options with success rate, and ethical considerations for usage of HCV-positive donors. Liver Transplantation 24 831-840 2018 AASLD.

Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

“…All donors undergo HCV‐antibody testing and nucleic acid testing for HCV RNA. Donors who are HCV antibody–positive and HCV RNA–negative pose a very low risk of HCV transmission to the recipient . Rarely, high‐risk donors with very recent HCV exposure who are anti‐HCV‐positive and HCV RNA–negative may pose a transmission risk .…”

Pro: Use of Hepatitis C Virus–Positive Donors Should Be Considered Standard of Care

“…Discard of HCV + donor organs should be reconsidered because DAA therapy has revolutionized HCV treatment via well‐tolerated, highly effective regimens (Table ) exhibiting sustained virological response rates (SVR12) greater than 95% . Several large series demonstrate that DAA therapy is equally effective among HCV + transplant recipients, with cure rates near 100% predominately using 12‐week, interferon‐ and ribavirin‐free regimens . As a result of these data, national guidelines clearly support the use of DAAs to cure HCV post transplant…”

Transplantation of Livers From Viremic Hepatitis C Virus–Positive Donors Into Hepatitis C Virus–Negative Recipients

“…In the United States, the rate of death from drug overdoses has increased exponentially . Using the United Network for Organ Sharing database from 2015 to 2016, Kling et al showed that 4.35% of all donors were viremic for HCV, and this number is increasing with the opioid epidemic .…”

“…Using the United Network for Organ Sharing database from 2015 to 2016, Kling et al showed that 4.35% of all donors were viremic for HCV, and this number is increasing with the opioid epidemic . The transplant community’s interest in the use of HCV positive donors for HCV negative recipients has recently increased . However, it is controversial which HCV negative patients should receive those livers .…”

“…The transplant community’s interest in the use of HCV positive donors for HCV negative recipients has recently increased . However, it is controversial which HCV negative patients should receive those livers . Until more data on long‐term direct‐acting antiviral treatment is available, it makes sense to use them in patients with increased risk of mortality or patients with very poor quality of life and low chance of receiving a transplant.…”