Long wait over: HCV-infected patients can receive HCV-positive liver
Patients infected with hepatitis C virus (HCV) who are in need of a transplant can safely receive a liver from an HCV-positive donor with a healthy liver biopsy, according to an analysis of outcomes spanning over 18 years.
The finding should offer “comfort” to doctors and their patients, given that HCV can now be cured in almost all patients after a transplant with the introduction of direct-acting antiviral therapy, said lead researcher Dr. Zobair Younossi from Inova Fairpax Hospital in Falls Church, Virginia, US.
“HCV-positive allografts could now be a reasonably safe option for patients with chronic HCV infection who are in need of a liver transplant.”
In the study, HCV-infected patients who were transplanted with an HCV-positive liver did just as well as those who received an HCV-negative liver. Death and graft loss were comparable between patients who received an HCV-positive liver and those who received an HCV-negative liver (p>0.05 for all), Younossi said.
However, he clarified that an HCV-positive liver cannot be safely transplanted into a hepatitis C-negative recipient because of the risk of causing runaway hepatitis in an immunosuppressed hepatitis C-negative patient.
The researchers analysed data from 33,668 hepatitis C-positive patients who underwent transplantation from 1995 through 2013 and were listed in the US Scientific Registry of Transplant Recipients. Of these, 1,930 or 5.7 percent received hepatitis C-positive donor liver. [EASL-ILC 2016, abstract PS040]
The more recent the transplantation the lower the rates of mortality (adjusted hazard ratio [HR], 0.978; p<0.0001) and graft loss (adjusted HR, 0.960;
“Overall survival dropped from just below 100 percent in the first year to over 50 percent after 10 years,” Younossi said.
Many doctors in the US have been using “theoretically suboptimal donors” as patients could not wait any longer, he added.
“The rates at which HCV-infected liver were being used tripled from 3 percent in 1995 to 9 percent in 2013.”
However, Dr. Tom Hemming Karlsen of the Oslo University Hospital in Oslo, Norway, who was not part of the study, commented: “We should not jump to the conclusion that there is now a donor pool that should be generally available... this is only for patients who already have HCV.”
More studies are therefore warranted to establish evidence-based selection criteria for HCV-positive donors that will provide patients with the best possible risk-to-benefit ratio.