Outcomes following liver transplantation from HCV-seropositive donors to HCV-seronegative recipients

Bashar A Aqel, Karn Wijarnpreecha, Surakit Pungpapong, C. Burcin Taner, Kunam Reddy, Michael Leise, Lanyu Mi, Rolland C. Dickson

Research output: Contribution to journalArticlepeer-review

Abstract

Background & Aims: Grafts from HCV-seropositive donors can now be considered for liver transplantation (LT) owing to the advent of direct-acting antivirals (DAAs). We report on our multicenter experience of transplanting liver grafts from HCV-seropositive donors into HCV-seronegative recipients. Methods: This is a prospective multicenter observational study evaluating outcomes in adult HCV-seronegative LT recipients who received grafts from HCV-seropositive donors in 3 US centers. Results: From 01/18 to 09/19, 34 HCV-seronegative LT recipients received grafts from HCV-seropositive donors (20 HCV-viremic and 14 non-viremic). Seven grafts were from cardiac-dead donors. The median MELD-Na score at allocation was 20. Six recipients underwent simultaneous liver-kidney transplant and 4 repeat LT. No recipient of an HCV-non-viremic graft developed HCV viremia. All 20 patients who received HCV-viremic grafts had HCV viremia confirmed within 3 days after LT. DAA treatment was started at a median of 27.5 days after LT. Median pre-treatment viral load was 723,000 IU/ml. All (20/20) patients completed treatment and achieved SVR12. Treatment was well tolerated with minimal adverse events. One patient developed HCV-related acute membranous nephropathy that resulted in end-stage kidney disease, despite achieving viral clearance. This patient died due to presumed infectious complications. A recipient of an HCV-non-viremic graft died with acute myocardial infarction 610 days post LT. Conclusions: Transplantation of liver grafts from HCV-seropositive donors into HCV-seronegative recipients resulted in excellent short-term outcomes. Antiviral therapy was effective and well tolerated. Careful ongoing assessment and prompt initiation of antiviral therapy are recommended. Longer term follow-up in carefully conducted clinical trials is still required to confirm these results. Lay summary: This study shows that livers from donors exposed to HCV expand the donor pool and can be used safely in patients who are seronegative for hepatitis C infection. Treatment, initiated early post transplantation, is effective and resulted in cure in all patients.

Original languageEnglish (US)
Pages (from-to)873-880
Number of pages8
JournalJournal of hepatology
Volume74
Issue number4
DOIs
StatePublished - Apr 2021

Keywords

  • DAA
  • DCD
  • Direct-acting antiviral
  • Donation after cardiac death
  • Glecaprevir/pibrentasvir
  • Hepatitis C
  • Liver transplantation

ASJC Scopus subject areas

  • Hepatology

Fingerprint Dive into the research topics of 'Outcomes following liver transplantation from HCV-seropositive donors to HCV-seronegative recipients'. Together they form a unique fingerprint.

Cite this