Hepatitis C Virus NAT‐Positive Solid Organ Allografts Transplanted Into Hepatitis C Virus–Negative Recipients: A Real‐World Experience

Abstract

Background and Aims Hepatitis C virus (HCV)‐viremic organs are underutilized, and there is limited real‐world experience on the transplantation of HCV‐viremic solid organs into recipients who are HCV negative. Approach and Results Patients listed or being evaluated for solid organ transplant after January 26, 2018, were educated and consented by protocol on the transplantation of HCV‐viremic organs. All recipients were HCV nucleic acid test and anti‐HCV antibody negative at the time of transplant and received an HCV‐viremic organ. The primary outcome was sustained virological response (SVR) at 12 weeks after completion of direct‐acting antiviral (DAA) therapy (SVR12). Seventy‐seven patients who were HCV negative underwent solid organ transplantation from a donor who was HCV viremic. No patients had evidence of advanced hepatic fibrosis. Treatment regimen and duration were at the discretion of the hepatologist. Sixty‐four patients underwent kidney transplant (KT), and 58 KT recipients had either started or completed DAA therapy. Forty‐one achieved SVR12, 10 had undetectable viral loads but are not eligible for SVR12, and 7 remain on treatment. One KT recipient was a nonresponder because of nonstructural protein 5A resistance. Four patients underwent liver transplant and 2 underwent liver‐kidney transplant. Three patients achieved SVR12, 1 has completed DAA therapy, and 2 remain on treatment. Six patients underwent heart transplant and 1 underwent heart‐kidney transplant. Six patients achieved SVR12 and 1 patient remains on treatment. Conclusions Limited data exist on the transplantation of HCV‐viremic organs into recipients who are HCV negative. Our study is the largest to describe a real‐world experience of the transplantation of HCV‐viremic organs into recipients who are aviremic. In carefully selected patients, the use of HCV‐viremic grafts in the DAA era appears to be efficacious and well tolerated.

Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

“…Limited short-term data from liver, (340,357,390,391) kidney, (358,(378)(379)(380)(390)(391)(392)(393)(394) heart, (359,373,390,395) and lung (359,374) transplant programs performing solid organ transplantations involving HCV-viremic donors and HCV-negative recipients are encouraging. However, the overall number of published cases is limited, and treatment approaches varied.…”

Immediate administration of antiviral therapy after transplantation of hepatitis C-infected livers into uninfected recipients: Implications for therapeutic planning

“…Delaying the treatment of HCV‐negative recipients transplanted with NAT‐positive organs increases the risk for adverse outcomes. Kapila et al reported the development of fibrosing cholestatic hepatitis in two HCV‐negative patients transplanted with kidneys from viremic donors . Those patients presented on postoperative day 3 and week 24, respectively, with deranged liver function tests and HCV viral loads >100 000 000 IU/mL.…”

Use of Hepatitis C Nucleic Acid Test–Positive Liver Allografts in Hepatitis C Virus Seronegative Recipients

“…One strategy to overcome the organ shortage would be to use organs from HCV NAT+ donors for transplantation into HCV NAT– patients. ( 12,21,22 ) Transplant programs are already using organs from HCV+ donors into recipients with HCV infection. ( 19,20 ) This matched cohort study represents the largest report of HCV NAT+ livers transplanted to NAT– recipients to date in a prospective IRB–approved study.…”