Clinician and patient attitudes toward use of organs from hepatitis C viremic donors and their impact on acceptance: A contemporary review

Abstract

Background The use of Hepatitis C (HCV) NAT positive allografts remains unusual and is clustered at few centers. We conducted a contemporary literature review to assess whether patient and clinician attitudes toward viremic organs impact acceptance. Methods Databases including PubMed, MEDLINE, and SCOPUS databases were reviewed to identify studies focused on evaluating patient and provider perceptions of HCV NAT positive organ use within the DAA era (January 2015–April 2021). Search included MeSH terms related to Hepatitis C, transplantation, and patient and clinician attitudes. Two investigators extracted study characteristics including information on willingness to accept viremic organs, HCV‐specific outcomes knowledge, HCV‐specific concerns, and factors that contributed to acceptance or non‐acceptance. Results Eight studies met all inclusion criteria. These included three pretransplant patient‐directed studies, two post‐transplant patient‐directed studies, one pre‐ and post‐transplant patient‐directed study, and two clinician‐directed studies. Common themes identified were concerns regarding HCV cure rates, viremic organ quality, DAA cost, stigma, and the possibility of HCV transmission to household members. The perception of decreased waitlist time was associated with viremic organ acceptance. Physician trust played a mixed role in acceptance patterns. Conclusions Knowledge of high cure rates, shorter waitlist times, and higher organ quality appear to have the highest impact on organ acceptance.

Use of preprocurement biopsy in donation after circulatory death liver transplantation

“…Despite evidence demonstrating excellent outcomes after transplantation of solid organs from HCV-positive individuals, hesitance still exists in the acceptance of these organs for transplant from some recipients and providers. [13,14] In kidney transplantation, concerns exist among providers regarding the inferiority of transplant outcomes from HCV NAT-positive donors. [15,16] Many potentially useable HCV-positive liver allografts are not being transplanted each year, with a majority of those that are being transplanted occurring at a small number of centers.…”

A systematic review of direct acting antiviral therapies in hepatitis C virus‐negative liver transplant recipients of hepatitis C‐viremic donors

“…[46][47][48] A literature review was conducted assessing the impact of clinician and patient attitudes on acceptance of HCV-viremic donors. 49 Common concerns identified included DAA treatment cost and efficacy, organ quality, risk of HCV transmission, and the stigma associated with HCV infection. The authors noted that perceptions of high HCV cure rates, shorter waitlist times, and higher organ quality had the greatest impact on organ acceptance, whereas concerns of post-transplant stigma were more common among those unwilling to accept these organs.…”

“…Despite favorable short‐term outcomes, barriers to acceptance of HCV‐viremic allografts have been reported, including a lack of understanding about HCV disease, the potential for disease transmission, access to DAA treatment, and management while on antiviral therapy (Table 4). 46–48 A literature review was conducted assessing the impact of clinician and patient attitudes on acceptance of HCV‐viremic donors 49 . Common concerns identified included DAA treatment cost and efficacy, organ quality, risk of HCV transmission, and the stigma associated with HCV infection.…”

Outcomes of kidney, liver, and simultaneous liver and kidney transplants from hepatitis c infected donors to hepatitis c naïve recipients: A large single center experience

“…9,10 Acceptance of these HCV+ organs by patients depends heavily on their perception of curability, post-transplant outcomes, and overall organ quality compared to HCV-organs. 11 Further, there is a diversity of approaches regarding patient education, DAA management, and viral monitoring. 12 Center-identified barriers to broader use of organs from HCV+ donors include concerns about the cost of DAA therapy, insurance coverage for patients, and the risk of chronic infection due to treatment failure from resistant virus.…”

“…In comparison to non‐viremic organs in 2019, NAT+ kidneys had 48% higher odds of being non‐use, and NAT+ livers had a non‐use rate of 30.7% compared to non‐viremic livers’ non‐use rate of 13.8% 9,10 . Acceptance of these HCV+ organs by patients depends heavily on their perception of curability, post‐transplant outcomes, and overall organ quality compared to HCV‐ organs 11 . Further, there is a diversity of approaches regarding patient education, DAA management, and viral monitoring 12 .…”