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HCV-positive organs safe long-term, offer transplant solution for patients with HCV

BARCELONA — Medium to long-term survival and other outcomes of liver transplant recipients with hepatitis C virus infection transplanted from HCV-positive donors were similar to patients who had HCV-negative donors, according to data presented at International Liver Congress.

“Data show that HCV has increased by 14% in the past decade for patients who require transplantation. … The shortage of organs has led to the use of suboptimal organs —  such as HCV-positive organs — in some cases,” Zobair Younossi, MD, MPH, chairman of the department of medicine, Inova Fairfax Hospital, and vice president for research of Inova Health System, said during his presentation at a press conference.

Zobair Younossi

With an objective to determine long-term outcomes of the use of HCV-positive organs for liver transplantation, researchers evaluated data of 33,688 HCV-positive patients transplanted between 1995 and 2013 found in the Scientific Registry of Transplant Recipients. Of these, 5.7% received an HCV-positive organ (n = 1,930). Long-term graft loss and mortality in those who were transplanted from HCV-positive donors were compared with HCV-negative donors.

“We used data from between 1995 and 2013 because prior to 1995, there was not always accurate testing for HCV in both organs and donors,” Younossi said.

Results indicated the number of HCV-positive donors steadily increased from 2.9% in 1995 to 9.4% by 2013.

Younossi said a majority of the HCV-positive patients were older, had hepatocellular carcinoma and were black.

“We know some of these patients, especially those with liver cancer, can’t wait long and elect to have a positive donor,” Younossi said.

Recipients who had HCV-positive donors were more likely to be discharged alive after the transplant (95.4%) compared with HCV-negative donors (93.9%; P = .006). However, this difference was accounted for based on a greater number of HCV-positive donors in more recent study years (P = .1 after adjustment for the study year).

After transplantation, mortality rates for HCV patients transplanted from HCV-positive donors were 12.5% in 1 year; 24.2% in 3 years; 33% in 5 years; and 47.5% in 10 years, with a graft loss rate of 2.2% in 1 year; 4.8% in 3 years; 7.5% in 5 years; and 13.9% in 10 years.

Younossi noted that these results were similar to those in HCV patients who received organs from HCV-negative donors (P > .05 for all).

No association was observed between a donor’s HCV positivity with the time to post-transplant mortality and time to graft loss in a proportion hazard survival analysis after adjusting for the year of transplantation (P > .4 for both).

“The post-transplant survival is similar in both groups. … One thing associated with better outcomes were more recent transplants,” Younossi said.

“The use of HCV-positive donors for HCV-positive patients will probably provide one option to deal with current organ shortages,” Younossi concluded, adding that he does not see this practice becoming universal for all patients who need a liver transplant — regardless of HCV status — since severe acute hepatitis may occur post-transplant in patients who are HCV-negative and receive an infected organ. – by Melinda Stevens 

Reference:

Stepanova M, et al. Abstract PS040. Presented at: International Liver Congress; April 13-17, 2016; Barcelona.

Disclosure: The researchers report no relevant financial disclosures.