Using organs from patients classified as hepatitis C virus (HCV) increased-risk donors (IRD) should be considered to address the shortages of donor tissue, according to a prospective cohort study presented at the Liver Meeting 2017: American Association for the Study of Liver Diseases.
HCV IRD are those who meet the Public Health Services criteria for increased risk for infection transmission, or those who had detectable HCV RNA in liver tissue after spontaneous or treatment-induced HCV RNA clearance from serum (anti-HCV positive/serum nucleic acid test negative).
Twenty-five anti-HCV-negative candidates (58% male, age 58 years, with an average model for end-stage liver disease score of 22) who received livers from HCV IRD sources were tested for HCV transmission using the HCV nucleic acid test 3 months after transplant.
Transmission occurred in 4 patients (16%), 3 of whom were women, 1 with prior history of HCV/HIV coinfection. Three were treated with direct-acting antiviral therapy; a fourth died 10 months later because of postoperative complications.
Of those treated with direct-acting antivirals, 1 completed 12 weeks of treatment and achieved end-of-treatment response, whereas the 2 remaining are still undergoing treatment and were aviremic at 2 and 4 weeks of treatment.
These results suggest the risk for HCV transmission from this high-risk donor pool is 16%, and because of the availability of safe and effective HCV direct-acting antiviral therapies, the use of these donors should be considered to increase the donor pool.
Madison Cuffy discloses speaking and teaching activities with Ethicon Inc.
Bari K, Luckett K, Kaiser TE, et al. Risk of hepatitis C transmission from antibody positive-nucleic acid negative liver organs to antibody negative recipients. [AASLD abstract 1]. Hepatology. 2017;66:1-148. doi: 10.1002/hep.29500