S1074 Evaluating Immediate Outcomes of Liver Transplantation With HCV Positive Donor Grafts

Abstract

Introduction: Currently, there is a shortage of available deceased donors to meet the demands of the liver transplant (LT) waitlist, resulting in a mortality rate of 12.3 per 100 waiting list years in 20191. The advent of safe, effective treatment for hepatitis C virus (HCV) has permitted use of HCV infected grafts for LT. Here we performed a descriptive analysis comparing immediate transplant related outcomes in patients who received an HCV+ graft and those who did not. Methods: This is a single center prospective cohort study of patients listed for OLT from April 2018 - June 2020. We compared immediate transplant outcomes of (1) patients willing vs. unwilling to receive an HCV+ graft and (2) recipients of HCV+ liver (antibody or nucleic acid testing [NAT] positive) vs. all other LT recipients. Stata v14.0 software was used for descriptive statistics using Chi-squared testing for categorical variables and Kruskal-Wallis test for continuous variables. Results: 146 patients were enrolled in the study of which 111 underwent LT. 86 were willing to accept an HCV+ graft and 25 declined. 15 patients received a HCV+ graft, of which 10 were NAT positive. Among those willing to receive an HCV+ liver, there was no significant difference in patient or donor age. There was a trend toward decreased transplant wait time for patients willing to accept HCV+ livers (171 vs. 237 days; p=0.07). Patients who received an HCV+ graft had significantly shorter cold ischemic time (351 vs. 426 minutes, p=0.01) and a shorter hospital length of stay after LT (10 vs. 15 days, p=0.02). Between HCV+ vs HCV- liver recipients, there was no difference in recipient age, donor age, time to transplant, warm ischemic time, need for reoperation, post transplant diabetes, or place of disposition following LT. Conclusion: Our data demonstrates that patients who received an HCV+ graft had a shorter cold ischemic time and hospital length of stay after LT. The difference in cold ischemic time likely reflects the use of donors more local to the LT center. A shorter ischemic time might confer improved immediate allograft function which might explain the reduced hospitalization amongst our HCV+ liver recipient patients. The shorter length of stay after LT likely reflects patient selection and use of HCV+ organs in those with lower MELD score. Further work is needed to understand long-term outcomes following use of HCV+ grafts.