The rise of the opioid epidemic and hepatitis C–positive organs

Abstract

The use of hepatitis C virus (HCV)-positive organs in liver transplantation (LT) has increased in the era of direct-acting antiviral therapy. A rising demand for organs, the increased ability to effectively treat HCV infection in the transplant setting, and an unprecedented increase in HCV-positive donors have all contributed to this trend. A recent abrupt rise in opioid use in the United States has resulted in a surge of injection drug use, transmission of HCV, and opioid-related overdose deaths. Geographical areas most affected by the opioid epidemic have experienced a rapid increase in recovery and utilization of HCV-positive donor organs, in which the proportion of deceased donor LTs in the United States from donors who are HCV positive has increased nearly 2-fold within the last 3 years. The prospect of expanding the organ donor pool with HCV-positive donors and achieving acceptable posttransplant outcomes has generated much interest in the areas of liver, kidney, and thoracic transplantation, including the potential for transplanting organs from HCV positive donors into HCV-negative recipients. Developing strategies to ensure appropriate selection of potential recipients of HCV-positive organs, initiating timely antiviral therapy, and defining associated risks will be critical in achieving optimal posttransplant outcomes in this setting. (Hepatology 2018;67:1600-1608).

Liver transplantation for hepatitis C virus (HCV) non-viremic recipients with HCV viremic donors

“…Figure 3 and Table S1 show the biochemical parameters and immunosuppression levels during and after DAA treatment for each of these patients. 4,7 Despite the availability of DAA therapy for posttransplant HCV, a positive HCV antibody continues to be a risk factor for organ discard. time that the transplanted organ is exposed to HCV.…”

“…4,7,8 The aim of our study was to summarize the posttransplant outcomes after donor-derived HCV infection in non-viremic liver transplant recipients at our institution. 4,7,8 The aim of our study was to summarize the posttransplant outcomes after donor-derived HCV infection in non-viremic liver transplant recipients at our institution.…”

“…4,7,8 The aim of our study was to summarize the posttransplant outcomes after donor-derived HCV infection in non-viremic liver transplant recipients at our institution. 1 In the context of this organ shortage, it is essential to make the best use of all transplantable organs.…”

Transplanting hepatitis C virus–positive livers into hepatitis C virus–negative patients with preemptive antiviral treatment: A modeling study

“…We found that the Regional Share 35 rule did not change our results—HCV‐negative patients with MELD ≥20 would still benefit from willing to accept HCV‐positive liver (http://onlinelibrary.wiley.com/doi/10.1002/hep.29723/suppinfo). We also conducted an additional analysis to evaluate the impact of the recently reported HCV‐positive organ rate of 26.7% observed in Ohio, which belongs to UNOS Region 10 . We found that though the clinical benefit increased for national as well as Region 10 results, the MELD threshold above which a patient is willing to accept HCV‐positive livers did not change, that is, MELD 20 (http://onlinelibrary.wiley.com/doi/10.1002/hep.29723/suppinfo).…”

“…As a result, their likelihood of receiving a liver was higher than if they were not open to accepting an HCV‐positive liver—we therefore increased the rate of receiving a liver by 5.9%, which corresponds to the proportion of HCV‐infected livers among all liver donors in the United States. In the sensitivity analysis, we varied this percentage using a wide range of 2.9%‐26.7%, corresponding to the lowest and highest HCV‐positive organ rates observed in different UNOS regions . If a patient received an HCV‐negative liver, he or she followed the path described in the above scenario (Fig.…”