Increasing Utilization and Excellent Initial Outcomes Following Liver Transplant of Hepatitis C Virus (HCV)-Viremic Donors Into HCV-Negative Recipients: Outcomes Following Liver Transplant of HCV-Viremic Donors

Thomas G. Cotter, Sonali Paul, Burhaneddin Sandıkçı, Thomas Couri, Adam S. Bodzin, Ester C. Little, Vinay Sundaram, Michael Charlton

Research output: Contribution to journalArticlepeer-review

58 Scopus citations

Abstract

Direct-acting antiviral (DAA) therapy has altered the frequency and outcome of liver transplantation (LT) for hepatitis C virus (HCV). The high efficacy and tolerability of DAA therapy has also created a rationale for utilizing HCV-viremic (HCV-RNA–positive) donors, including into HCV-negative recipients. We examined trends in frequency of organ utilization and graft survival in recipients of HCV-viremic donors (HCV-RNA positive as measured by nucleic acid testing [NAT]). Data were collected from the Scientific Registry of Transplant Recipients (SRTR) on adult patients who underwent a primary, single-organ, deceased donor LT from January 1, 2008 to January 31, 2018. Outcomes of HCV-negative transplant recipients (R) who received an allograft from donors who were HCV-RNA positive (DNAT+) were compared to outcomes for R patients who received organs from donors who were HCV-RNA negative (DNAT). There were 11,270 DNAT/R; 4,748 DNAT/R+; 87 DNAT+/R; and 753 DNAT+/R+ patients, with 2-year graft survival similar across all groups: DNAT/R 88%; DNAT/R+ 88%; DNAT+/R 86%; and DNAT+/R+ 90%. Additionally, there were 2,635 LTs using HCV antibody-positive donors (DAb+): 2,378 DAb+/R+ and 257 DAb+/R. The annual number of DAb+/R transplants increased from seven in 2008 to 107 in 2017. In the post-DAA era, graft survival improved for all recipients, with 3-year survival of DAb+/R patients and DAb+/R+ patients increasing to 88% from 79% and to 85% from 78%, respectively. Conclusion: The post-DAA era has seen increased utilization of HCV-viremic donor livers, including HCV-viremic livers into HCV-negative recipients. Early graft outcomes are similar to those of HCV-negative recipients. These results support utilization of HCV-viremic organs in selected recipients both with and without HCV infection.

Original languageEnglish (US)
Pages (from-to)2381-2395
Number of pages15
JournalHepatology
Volume69
Issue number6
DOIs
StatePublished - Jun 2019
Externally publishedYes

ASJC Scopus subject areas

  • Hepatology

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