Long-term outcomes of liver transplantation in patients with hepatitis C infection are not affected by HCV positivity of a donor

Abstract

BackgroundThe use of HCV-positive livers for HCV-positive recipients is becoming more common. Our aim is to evaluate long-term outcomes in liver transplant recipients transplanted with HCV antibody-positive organs.MethodsFrom the Scientific Registry of Transplant Recipients (1995–2013), we selected all adult liver transplant recipients with HCV, and cross-sectionally compared long-term graft loss and mortality rates between those who were transplanted from HCV antibody-positive (HCV+) vs. HCV antibody-negative donors.ResultsWe included 33,668 HCV+ liver transplant recipients (54.0 ± 7.7 years old, 74.1% male, 71.0% white, 23.6% with liver malignancy). Of those, 5.7% (N = 1930) were transplanted from HCV+ donors; the proportion gradually increased from 2.9% in 1995 to 9.4% in 2013. Patients who were transplanted from HCV+ positive donors were more likely to be discharged alive after transplantation (95.4% vs. 93.9%, p = 0.006), but this difference was completely accounted for by a greater proportion of HCV+ donors in more recent study years (p = 0.10 after adjustment for the transplant year). After transplantation, both mortality in HCV patients transplanted from HCV+ donors (12.5% in 1 year, 24.2% in 3 years, 33.0% in 5 years) and the graft loss rate (2.2% in 1 year, 4.8% in 3 years, 7.5% in 5 years) were similar to those in HCV patients transplanted from HCV-negative donors (all p > 0.05).ConclusionsOver the past two decades, the use of HCV+ organs for liver transplantation has tripled. Despite this, the long-term outcomes of HCV+ liver transplant recipients transplanted from HCV+ donors were not different from those who were transplanted with HCV-negative organs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-016-0551-z) contains supplementary material, which is available to authorized users.

Attitudes of Liver Transplant Candidates Toward Organs From Increased‐Risk Donors

“…Recently, Durand et al have also reported equally good longterm patient survival between recipients of overdose drug donors compared with both trauma and medical death donors. Similarly, longterm outcomes of recipients of an HCV positive liver transplantation with organs from HCV‐positive donors are similar to those of HCV‐negative recipients based on a recent Scientific Registry of Transplant Recipients analysis, indicating equally good outcomes regardless of the viral status of the donor . We found a significant improvement in the likelihood of organ acceptance when we informed patients that the risk of contracting HIV/HCV is lower than the risk from many daily activities and that the transplanted IRD organ may be of a significantly better quality, may be transplanted sooner, and may lead to a similar outcome as transplantation with a non‐IRD organ.…”

Improved Graft Survival After Liver Transplantation for Recipients With Hepatitis C Virus in the Direct‐Acting Antiviral Era

“…The poor efficacy of HCV treatments prior to the DAA era translated to graft injury and loss or recurrent cirrhosis. In the pre‐DAA era, mortality in HCV patients transplanted from HCV‐positive donors has been shown to be 12.5% at 1 year, 24.2% at 3 years, and 33.0% at 5 years, with a graft loss rate of 2.2% at 1 year, 4.8% at 3 years, and 7.5% at 5 years with no difference noted in those transplanted with HCV‐negative donors . Conversely, although access to medication remained a problem, in the DAA era HCV‐positive liver transplant recipients have had improved early graft survival compared with those treated in the pre‐DAA era .…”

Maximizing donors with viral hepatitis in the current era

“…In kidney recipients, the risk of having received an HCV‐positive kidney translated to a 1% lower survival at 1 year and a 2% lower survival at 3 years, while the benefits to patients were potentially significant, as HCV‐positive recipients who underwent transplantation with HCV‐positive kidneys spent over a year less time on the waiting list than those HCV‐positive recipients who waited for HCV‐negative kidneys at the same transplant center . Liver recipient's mortality and graft loss at 1, 3, and 5 years was not significantly different in the HCV‐positive liver recipients of HCV‐positive or HCV‐negative donors …”

“…It is well recognized that utilization of HCV organs is lower than that of HCV‐negative organs . The argument that many have made is that this is due to the lack of acceptable HCV‐positive recipients.…”

“…Currently, if one assumes a 6% rate of HCV positivity in the kidney waiting list, there would be approximately 6000 patients with HCV who could receive an HCV‐positive kidney if available. Furthermore, using SRTR data, a review of 33,668 HCV‐positive liver recipients transplanted from 1995 to 2013 found that overall, only 5.7% of patients underwent transplantation using an HCV‐positive organ . Although the proportion of patients with HCV transplanted with an HCV‐positive organ increased over time, only 9.4% of all liver recipients in 2013 received an HCV‐positive organ.…”