Faculty Opinions recommendation of Changes in Utilization and Discard of Hepatitis C-Infected Donor Livers in the Recent Era.

Abstract

The impact of interferon (IFN)-free direct acting antiviral (DAA) hepatitis C virus treatments on utilization and outcomes associated with HCV+ deceased-donor liver transplantation (DDLT) is largely unknown. Using SRTR, we identified 25,566 HCV+ DDLT recipients from 2005 to 2015, and compared practices according to the introduction of DAA therapies using modified Poisson regression. The proportion of HCV+ recipients who received HCV+ livers increased from 6.9% in 2010 to 16.9% in 2015. HCV+ recipients were 61% more likely to receive an HCV+ liver after 2010 (early DAA/IFN era) [aRR: 1.45 1.61 1.79 , p<0.001] and almost three times more likely to receive one after 2013 (IFN-free DAA era) [aRR: 2.58 2.85 3.16 , p<0.001]. Compared to HCV− livers, HCV+ livers were 3 times more likely to be discarded from 2005-2010 [aRR: 2.69 2.99 3.34 , p<0.001], 2.2 times more likely after 2010 [aRR: 1.80 2.16 2.58 , p<0.001], and 1.7 times more likely after 2013 [aRR: 1.37 1.68 2.04 , p<0.001]. Donor HCV status was not associated with increased risk of all-cause graft loss (p=0.1), and this did not change over time (p=0.8).