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HCV-positive liver use increasing, discard rate steady

Researchers found that both donation and use of hepatitis C-positive livers has steadily increased over the last couple years due to a significant number of livers from younger individuals related to the rise of drug overdose-related deaths, according to a recently published study.

“With the option to use DAA-based therapy immediately following LT, HCV infection can be treated preemptively without significant hepatic dysfunction,” George Cholankeril, MD, from the Stanford University School of Medicine in California, and colleagues wrote. “In addition, donor liver biopsies at the time of organ procurement can help evaluate for underlying liver fibrosis and steatosis which can aid in the decision to utilize these procured donor livers.”

Cholankeril and colleagues accessed the UNOS database to analyze trends in liver donation from individuals who were HCV-positive based on nucleic acid testing and those who were HCV seropositive but non-viremic between Mar. 1, 2015, and Sept. 30, 2017.

HCV seropositive donor livers constituted 7% of all liver transplant surgeries in the U.S. during the study period, 65.1% of which were HCV-positive. In the same period, 30 HCV-positive livers were transplanted into recipients negative for HCV, 22 of which occurred in 2017.

Compared with other causes of death, drug overdose accounted for more than half of all HCV-positive deceased donor livers (P < .001). Additionally, HCV-positive livers were significantly more likely to be from younger individuals (P < .001) with lower liver donor risk index (P < .001) or risk for graft failure (P < .001).

HCV seropositive livers had a significantly higher discard rate compared with seronegative livers (30.7% vs. 13.8%; P < .001). While the researchers observed a sharp annual decline in discard rates of seronegative livers between 2016 (31.2%) and 2017 (24.8%), the annual discard rates for HCV-positive livers remained steadily above 30%.

Although limited to 1 year of follow-up, the researchers found no significant difference in posttransplant survival rates between recipients who received an HCV-positive liver and those who received an HCV non-viremic liver (92.2% vs. 91.9%).

“The timing and cost of DAA therapy, insurance authorization process, and donor and recipient selection remain undefined,” Cholankeril and colleagues wrote. “Therefore, it is recommended that an informed consent be obtained, and DAA therapy approval by insurance authorized or treatment conducted in the context of a clinical trial.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.