Hepatitis C Virus NAT-Positive Solid Organ Allografts Transplanted Into Hepatitis C Virus-Negative Recipients: A Real-World Experience

Hepatology. 2020 Jul;72(1):32-41. doi: 10.1002/hep.31011. Epub 2020 Apr 15.

Abstract

Background and aims: Hepatitis C virus (HCV)-viremic organs are underutilized, and there is limited real-world experience on the transplantation of HCV-viremic solid organs into recipients who are HCV negative.

Approach and results: Patients listed or being evaluated for solid organ transplant after January 26, 2018, were educated and consented by protocol on the transplantation of HCV-viremic organs. All recipients were HCV nucleic acid test and anti-HCV antibody negative at the time of transplant and received an HCV-viremic organ. The primary outcome was sustained virological response (SVR) at 12 weeks after completion of direct-acting antiviral (DAA) therapy (SVR12 ). Seventy-seven patients who were HCV negative underwent solid organ transplantation from a donor who was HCV viremic. No patients had evidence of advanced hepatic fibrosis. Treatment regimen and duration were at the discretion of the hepatologist. Sixty-four patients underwent kidney transplant (KT), and 58 KT recipients had either started or completed DAA therapy. Forty-one achieved SVR12 , 10 had undetectable viral loads but are not eligible for SVR12 , and 7 remain on treatment. One KT recipient was a nonresponder because of nonstructural protein 5A resistance. Four patients underwent liver transplant and 2 underwent liver-kidney transplant. Three patients achieved SVR12 , 1 has completed DAA therapy, and 2 remain on treatment. Six patients underwent heart transplant and 1 underwent heart-kidney transplant. Six patients achieved SVR12 and 1 patient remains on treatment.

Conclusions: Limited data exist on the transplantation of HCV-viremic organs into recipients who are HCV negative. Our study is the largest to describe a real-world experience of the transplantation of HCV-viremic organs into recipients who are aviremic. In carefully selected patients, the use of HCV-viremic grafts in the DAA era appears to be efficacious and well tolerated.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Allografts
  • Antiviral Agents / therapeutic use*
  • DNA, Viral / analysis*
  • Female
  • Heart Transplantation*
  • Hepacivirus / genetics*
  • Hepatitis C / prevention & control*
  • Hepatitis C / transmission
  • Humans
  • Kidney Transplantation*
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Nucleic Acid Amplification Techniques
  • Postoperative Complications / prevention & control*
  • Postoperative Complications / virology
  • Sustained Virologic Response
  • Tissue Donors
  • Viremia / virology

Substances

  • Antiviral Agents
  • DNA, Viral