Transplanting livers from Hepatitis C virus positive donors; is it worth the risk?

J.W. Mensink, B. van Hoek, B. Schaefer, M.D. van Rosmalen, I.P.J. Alwayn, A.E. Braat

Wednesday 4 march 2020

15:00 - 15:10h at Theaterzaal

Parallel session: Parallel sessie III – Klinische abstracts

Background: Before the introduction of Direct-Acting Antivirals (DAAs), only selected organs from Hepatitis C virus (HCV) positive donors were successfully transplanted into HCV positive recipients. Since HCV infection is now curable in a large percentage of cases (>95%) it may be possible to transplant organs from HCV positive donors to HCV negative recipients. In this study we aim to analyse current utilization of livers of HCV positive donors in the Eurotransplant (ET) region and its future potential.

Methods: All reported post-mortem organ donors with age ≥16 years in the ET region between January 2007 and December 2018 were included. Donors from outside the ET region were excluded. Segmental liver transplantations were excluded as well. First, donor demographics were evaluated for all reported donors by HCV status. Then, utilization and graft survival were analysed for both groups.

Results: A total 22,474 donors were reported in the ET region and 287 (1.3%) donors were tested positive for HCV antibodies (ab), with a range of 0.0-1.7% per country in the ET region. A total of 141 (49%) livers of the HCV ab positive donors were transplanted, 74/141 (53%) in HCV ab positive recipients. Graft failure occurred in 25/141 (18%) recipients directly or later after transplantation. In 5/141 (3.5%) it was due to recurrence of HCV. Of the 21,998 HCV ab negative donors 17,745 (81%) livers were transplanted, 2,245/17,745 (13%) in HCV ab positive recipients. In 2,585/17,745 (15%) recipients graft failure occurred directly or later after transplantation. Recurrence of HCV as cause of graft failure was in 77/17,745 (0.4%) of the recipients with graft failure.

Conclusions: Liver utilization is much higher in HCV ab negative donors as compared to HCV ab positive donors. However, graft failure overall and specifically due to HCV infection occurs in 18% and 3,5% respectively after liver transplantation of HCV ab positive donors. Therefore, the absolute risk is recipients of a HCV ab negative graft is only slightly higher. Although the number of HCV ab positive donors is not very high in the ET region, with the new DAAs there is an opportunity to improve utilization of HCV ab positive donors and outcome after liver transplantation. With the increasing waiting lists and relatively stable number of donors, transplant centers should consider all liver grafts of HCV positive donors for transplantation.