• J. Am. Coll. Surg. · Apr 2019

    Clinical Trial

    Use of Hepatitis C AB-Positive Donor Liver in Hepatitis C Nonviremic Liver Transplant Recipients.

    • Keith Luckett, Tiffany E Kaiser, Khurram Bari, Kamran Safdar, Michael R Schoech, Senu Apewokin, Tayyab S Diwan, Madison C Cuffy, Nadeem Anwar, and Shimul A Shah.
    • Department of Medicine and Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
    • J. Am. Coll. Surg. 2019 Apr 1; 228 (4): 560-567.

    BackgroundGiven the shortage of available liver grafts, transplantation (LTx) of hepatitis C virus antibody-positive, nucleic acid test-negative (HCV Ab+/NAT-) livers into nonviremic HCV recipients can expand the donor pool. Having previously described the sentinel experience of HCV Ab+/NAT- allografts in nonviremic recipients, we report the growth and extended follow-up of this program for 55 patients compared with recipients of Public Health Services (PHS) increased-risk donor HCV Ab-/NAT- allografts.Study DesignA prospective review of all HCV nonviremic LTx patients receiving HCV Ab+/NAT- organs between March 2016 and August 2018 was performed. All HCV Ab+/NAT- organ recipients underwent HCV testing at 3 months and 1-year post-LTx to determine HCV transmission.ResultsFifty-five HCV nonviremic candidates received HCV Ab+/NAT- organs; 64% male, median age 59 years (range 36 to 69 years) and median Model for End-Stage Liver Disease score of 22.5. Two recipients were excluded due to death before HCV testing. The HCV disease transmission occurred in 5 recipients (9%). Of these, 4 (80%) underwent anti-HCV treatment with eradication of virus. No patient found to be negative at 3 months seroconverted at 1-year follow-up. No patients who received PHS increased-risk donor HCV Ab-/NAT- organs had viremia develop (0 of 57) and there was no difference in graft and renal function, complications, or survival between HCV Ab+/NAT- recipients and PHS increased-risk donor HCV Ab-/NAT- recipients.ConclusionsWe report the largest experience with LTx from HCV Ab+/NAT- donors into 55 seronegative recipients with a HCV transmission rate of 9% with no late conversions at 1 year and no difference in function or graft loss compared with PHS increased-risk donor HCV Ab-/NAT- recipients. Due to availability of safe and effective HCV therapies, the use of such organs should be strongly considered to increase the donor organ pool.Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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