The American Society of Transplantation Consensus Conference on the Use of Hepatitis C Viremic Donors in Solid Organ Transplantation

Abstract

The availability of direct-acting antiviral agents for the treatment of hepatitis C virus (HCV) infection has resulted in a profound shift in the approach to the management of this infection. These changes have affected the practice of solid organ transplantation by altering the framework by which patients with end-stage organ disease are managed and receive organ transplants. The high level of safety and efficacy of these medications in patients with chronic HCV infection provides the opportunity to explore their use in the setting of transplanting organs from HCV-viremic patients into non-HCV-viremic recipients. Because these organs are frequently discarded and typically come from younger donors, this approach has the potential to save lives on the solid organ transplant waitlist. Therefore, an urgent need exists for prospective research protocols that study the risk versus benefit of using organs for hepatitis C-infected donors. In response to this rapidly changing practice and the need for scientific study and consensus, the American Society of Transplantation convened a meeting of experts to review current data and develop the framework for the study of using HCV viremic organs in solid organ transplantation.

Utilization of hepatitis C virus RNA–positive donor liver for transplant to hepatitis C virus RNA–negative recipient

“…HCV-resolved/cured (HCV Ab-positive/HCV RNA-negative). (2) The use of HCV-positive donor to HCV-positive recipient has been the standard of practice and is advocated. LT outcomes for HCV recipients who receive HCV-positive donors are comparable with those who receive HCV-negative allografts.…”

“…(2) Currently, there are no OPTN policies restricting transplantation of HCV-infected donors to HCV-positive or HCV-negative recipients. Because of the increase in mortality from drug overdose, it is estimated that this will be the main source of available HCV-infected livers in the next decade.…”

“…Because of the increase in mortality from drug overdose, it is estimated that this will be the main source of available HCV-infected livers in the next decade. (2) Similar to our donor, these organs are from young donors, without major underlying diseases, and with no or minimal liver fibrosis. These allografts are considered to be of better quality than organs from older HCV-viremic donors that can potentially have advanced liver fibrosis.…”

“…These allografts are considered to be of better quality than organs from older HCV-viremic donors that can potentially have advanced liver fibrosis. (2) Who are the appropriate HCV RNA-negative recipients for LT-from a HCV-infected donor? Who should be prioritized?…”

Response to: HCV viremic donors with hepatic bridging fibrosis: Are we ready to use their livers in the era of direct-acting antivirals?

“…As we mentioned in our report, we should see an increased number of HCV-infected baby boomers within the next decade who have more likelihood of hepatic fibrosis compared to the younger, drug-injecting population. 3 Clearly more data on using such higher risk grafts would be needed to establish criteria for acceptable graft fibrosis for donation, but we do feel this is an area of great interest to further expand the donor pool. We would like to make a few additional points with regard to However, the risk of graft failure with use of a fibrotic organ, particularly with bridging fibrosis or "near" cirrhosis as reported by the group, is likely to be greater than with use of a nonfibrotic organ.…”