Transplantation of Organs from Hepatitis C Virus-Positive Donors under Direct-Acting Antiviral Regimens

Abstract

There is a discrepancy between the patients requiring organ transplants and the donors available to meet that demand. Many patients die every year while on the waiting list, and there is a need to bridge this gap. For many years, medical practitioners have been apprehensive of using donor organs from donors who have tested positive for the Hepatitis C virus (HCV), and with good reason. HCV has been proven to be among the leading causes of liver diseases requiring liver transplants. Over the years, studies have been carried out to find a treatment for Hepatitis C. The advent of direct-acting antivirals revolutionized the medical world. These medication regimens have been proven to treat Hepatitis C in transplant patients effectively. This systematic review will examine how DAA treatments affect transplants of different organs from HCV-positive donors to HCV-negative recipients.

Vascularized Composite Allotransplantation of the Hand

“…131 However, the recent development of direct-acting antivirals offers a cure for patients with chronic HCV: this development has led to updates in the policies of some SOT centers that have successfully conducted SOT in HCV patients. 132,133 While one FT center has updated its policy to remove HCV as an exclusion criterion, this study did not identify similar changes among any HT centers. 14 Hence, these new data may encourage the field of HT to continually reevaluate medical eligibility criteria, especially in an attempt to improve access to otherwise ineligible patients.…”

“…Another concern is the reactivation of latent HCV in the setting of postoperative immunosuppression 131 . However, the recent development of direct-acting antivirals offers a cure for patients with chronic HCV: this development has led to updates in the policies of some SOT centers that have successfully conducted SOT in HCV patients 132,133 . While one FT center has updated its policy to remove HCV as an exclusion criterion, this study did not identify similar changes among any HT centers 14 .…”

A Pilot Trial for Prevention of Hepatitis C Virus Transmission From Donor to Organ Transplant Recipient With Short-Course Glecaprevir/Pibrentasvir

“…According to the US Organ Procurement and Transplantation Network, a total of 3440 organs were HCV-positive in 2021, accounting for 7.7% of all organ donors. With the advent of DAAs, excellent outcomes have been reported with the treatment of HCV in organ recipients, and utilization of such organs has dramatically increased [ 12–15 ]. At our center, approximately 100 transplant recipients have received organs from HCV-viremic donors since April 2017 (S.A. unpublished data, 2022).…”

Expanding the liver donor pool worldwide with hepatitis C infected livers, is it the time?

“…The influence of donor steatosis on the outcomes of liver transplants differs across studies due to the fact that the majority of transplant surgeons decline these organs, and there is presently no data regarding the use of HCV-positive fatty grafts[ 68 ].…”