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

Abstract

In the context of organ shortage, the opioid epidemic, and effective direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV), more HCV-infected donor organs may be used for liver transplantation. Current data regarding outcomes after donor-derived HCV in previously non-viremic liver transplant recipients are limited. Clinical data for adult liver transplant recipients with donor-derived HCV infection from March 2017 to January 2018 at our institution were extracted from the medical record. Ten patients received livers from donors known to be infected with HCV based on positive nucleic acid testing. Seven had a prior diagnosis of HCV and were treated before liver transplantation. All recipients were non-viremic at the time of transplantation. All 10 recipients derived hepatitis C infection from their donor and achieved sustained virologic response at 12 weeks posttreatment with DAA-based regimens, with a median time from transplant to treatment initiation of 43 days (IQR 20-59). There have been no instances of graft loss or death, with median follow-up of 380 days (IQR 263-434) posttransplant. Transplantation of HCV-viremic livers into non-viremic recipients results in acceptable short-term outcomes. Such strategies may be used to expand the donor pool and increase access to liver transplantation.

Keywords: clinical research/practice; liver allograft function/dysfunction; liver disease; liver transplantation/hepatology; organ acceptance.

Conflict of interest statement

Disclosure

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons.

Figures

Figure 1.

Trends in HCV viral load; reference line represents the start date of antiviral therapy.

Figure 2.

Biochemical parameters during post-transplant follow-up; reference line represents start date of antiviral therapy.

Figure 3.

Immunosuppression levels with relation to HCV therapy in liver transplant recipients with rejection. ACR = acute cellular rejection; AMR = antibody-mediated rejection; HCV = hepatitis C, VL = viral load, ALT = alanine aminotransferase, ALKP = alkaline phosphatase, SOF = sofosbuvir, LDV = ledipasvir, VEL = velpatasvir.