An Analysis of Hepatitis-C-Positive Liver Donors in the Era of Direct Acting Antiviral Therapies

Abstract

TITLE: An Analysis of Hepatitis-C-Positive Liver Donors in the Era of Direct Acting Antiviral Therapies Purpose: To determine whether the recent development of direct acting antiviral drugs (DAAs) has spurred an increase in the transplantation of livers from donors with hepatitis c virus (HCV) and to establish what percent of these livers come from donors with current versus cleared infection using NAT status. Methods: We retrospectively reviewed data from the United Network for Organ Sharing (UNOS) on all donors, wait-listed candidates and transplant recipients of livers, kidneys, hearts, lungs, intestines and pancreases in the United States from January 2009-March 2016. Data was analyzed using VirtualBox and SAS Studio. Results: Between 2009 and 2015, less than 5% of all liver transplants came from HCV-positive donors. However the number of HCV-positive livers used for transplant increased, particularly in 2013, when interferon-free DAAs were introduced. Most of these HCV-positive livers were transplanted into HCV-positive recipients (in 2015, 381 went to positive recipients compared to 12 to HCV-negative recipients) and the number of these D-positive/R-positive transplants increased since 2013. In terms of HCV-negative liver donors, more than half were transplanted into HCV-negative recipients, and the number transplanted into HCV-positive recipients decreased from 2014-15. This suggests an increasing propensity to give HCV-positive recipients an HCV-positive liver when previously more of those donations were discarded. Wait-list data showed that while HCV-positive recipients experience longer wait times for liver transplants compared to HCV-negative recipients, the disparity in wait times has decreased by more than 50% from 2000 to 2015. In terms of NAT status, of all organ donors (including heart, lung, liver, kidney, intestine, pancreas) evaluated for transplant between January 2015 and March 2016 that were HCV-antibody positive, two-thirds were also NAT-positive and one third were NAT-negative, reflecting current and cleared infection states, respectively. Conclusions: Our data indicate that the development of IFN-free DAAs has prompted increased usage of HCV-positive livers for transplantation, resulting in shorter wait times for all recipients. Thus enhanced use of HCV-positive donor organs offers hope for optimal organ utilization of a previously high-risk donor pool.