Hepatitis C‐positive donor liver transplantation for hepatitis C seronegative recipients

Abstract

ribonucleic acid; SVR12, sustained virologic response at 12 weeks after treatment; ULN, upper limit of normal. AbstractBackground: The opioid crisis has led to an increase in hepatitis C virus-positive donors in the past decade. Whereas historically hepatitis C seropositive organs were routinely discarded, the advent of direct-acting antiviral agents has notably expanded the utilization of organs from donors with hepatitis C. There has been growing experience with liver transplantation (LT) from hepatitis C seropositive donors to hepatitis C seropositive recipients. However, data remain limited on LT from hepatitis C seropositive or hepatitis C ribonucleic acid positive donors to hepatitis C seronegative recipients. Methods:We performed a retrospective study of 26 hepatitis C seronegative recipients who received hepatitis C seropositive donor livers followed by preemptive antiviral therapy with direct-acting antiviral treatment at the Johns Hopkins Hospital Results: Twenty-five of the 26 recipients are alive with proper graft function; 20 of them received livers from hepatitis C nucleic acid testing positive donors. All 12 recipients who completed their direct-acting antiviral courses and have reached sufficient follow-up for sustained virologic response have achieved sustained virologic response. Nine of our recipients have either completed direct-acting antiviral treatment without sufficient follow-up time for sustained virologic response or are undergoing direct-acting antiviral treatment. One patient is awaiting antiviral treatment initiation pending insurance approval. Of note, 11 of 12 patients with sustained virologic response received a hepatitis C nucleic acid testing positive donor liver.Conclusion: Hepatitis C seronegative patients who receive a hepatitis C seropositive or hepatitis C nucleic acid testing positive liver allograft can enjoy good short-term outcomes with hepatitis C cure following direct-acting antiviral treatment.

Post‐transplant survey to assess patient experiences with donor‐derived HCV infection

“…One type of shared cost is the copayment, or "copay," which is a fixed amount an individual pays for a specific service or prescription medication. 2 Since the advent of direct-acting antiviral (DAA) treatment, 3 there has been an increase in the use of HCV-V organs for transplant, [4][5][6][7][8] mostly within the clinical trial setting but also as part of real-world clinical practice protocols in which patients are responsible for the cost of DAA therapy, 9,10 which can be considerable. 11 Recent reports suggest excellent short-term outcomes with use of HCV-V organ transplantation.…”

Can HCV Viremic Organs Be Used in Liver Transplantation to HCV Negative Recipients?

“…Out of the 12 recipients who achieved SVR, 1 received Ledipasvir/Sofosbuvir for 12 weeks, 1 received Sofosbuvir/Velpatasvir for 8 days followed by Ledipasvir/Sofosbuvir for 23 weeks and 10 recipients were treated with Glecaprevir/Pibrentasvir for 12 weeks. [25] Wijarnpreecha et al presented a preliminary data of 22 HCV-seronegative LT recipients who received grafts from HCVseropositive donors (12 NAT positive, 9 NAT negative). DAA was initiated at a median of 28 days (range 6-67) post LT, resulting in undetectable HCV-RNA in all patients by week 8.…”

Donor Characteristics and Regional Differences in the Utilization of HCV-Positive Donors in Liver Transplantation

“…9 One of the reasons for this rise is the increasing utilization of HCV-positive donors for HCV-negative recipients, with studies reporting favorable results, including improved survival for recipients with a Model for End-Stage Liver Disease (MELD) score of 20 or greater due to less waitlist mortality. [10][11][12] However, there have been limited studies on the characteristics of HCV-positive donors and allografts.…”