Abstract
Background Prior to 2014, treatment for hepatitis C was limited. However, the subsequent introduction of direct acting antiviral medications (DAA) against hepatitis C led to improvements in morbidity and better medication tolerance. DAA therapy allowed for an increase in treatment rates of hepatitis C in patients on the liver transplant waiting list. With the popularization of DAA, there became a growing concern about the utility of hepatitis C-positive (HCV+) deceased liver donors, especially after treating HCV+ potential recipients on the transplant waiting list. Methods This is a retrospective, observational study using Mid-America Transplant Services (MTS) database from 2008 to 2017. Comparison was made before the widespread use of DAAs 2008–2013 (pre-DAA) against their common practice use 2014–2017 (post-DAA). All deceased liver donors with HCV antibody or nucleic acid positive results were evaluated. Results Between 2008 and 2017, 96 deceased liver donors were positive for HCV. In the pre-DAA era, 47 deceased liver donors were positive for HCV, of which 32 (68.1%) were transplanted and 15 (31.9%) were discarded. In the post-DAA era, a total of 49 HCV+ organs were identified, out of which 43 (87.8%) livers were transplanted and 6 (12.2%) were discarded. Discard rate was significantly higher in the pre-DAA population (31.9% vs. 12.2%, p = 0.026). Secondary analysis showed a distinct trend towards increased regional sharing and utilization of HCV+ donors. Conclusion In order to reduce discard rates of HCV+ patients, our data suggest that transplant centers could potentially delay HCV treatment in patients on the transplant waitlist.
Highlights
Hepatitis C virus (HCV) was a leading cause of liver cirrhosis and one of the most common indications for liver transplantation (LT)
Fibrosing cholestatic hepatitis can lead to rapid organ loss associated with high mortality [3]. ough these risks exist, multiple trials have shown that the use of HCV+ donors in HCV+ recipients carries no significant differences in graft survival or mortality rates when compared to non-HCV donors [4]
In the pre-direct acting antiviral medications (DAA) era, a total of 47 organ donors tested positive for HCV, of which 32 (68.1%) were transplanted and 15 (31.9%) were discarded
Summary
Hepatitis C virus (HCV) was a leading cause of liver cirrhosis and one of the most common indications for liver transplantation (LT). Some transplant centers have carefully utilized HVC-positive deceased liver donors—in the absence of advanced fibrosis or significant steatosis—to transplant HCV+ recipients, such a practice has not been uniformly adopted across all centers. DAA therapy allowed for an increase in treatment rates of hepatitis C in patients on the liver transplant waiting list. With the popularization of DAA, there became a growing concern about the utility of hepatitis C-positive (HCV+) deceased liver donors, especially after treating HCV+ potential recipients on the transplant waiting list. All deceased liver donors with HCV antibody or nucleic acid positive results were evaluated. In the pre-DAA era, 47 deceased liver donors were positive for HCV, of which 32 (68.1%) were transplanted and 15 (31.9%) were discarded. In the post-DAA era, a total of 49 HCV+ organs were identified, out of which 43 (87.8%) livers were transplanted and 6 (12.2%) were discarded. In order to reduce discard rates of HCV+ patients, our data suggest that transplant centers could potentially delay HCV treatment in patients on the transplant waitlist
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