Department of Medicine and Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
Department of Medicine and Surgery, University of Cincinnati School of Medicine, Cincinnati, OH. Electronic address: Shimul.firstname.lastname@example.org.
Given the shortage of available liver grafts, transplantation (LTx) of Hepatitis C antibody positive, nucleic acid test negative (HCV Ab+/NAT-) livers into non-viremic HCV recipients may expand the donor pool. Having previously described the sentinel experience of HCV Ab+/NAT- allografts in non-viremic recipients, we report the growth and extended follow-up of this program for 55 patients compared to recipients of PHS increased risk donor (IRD) HCV Ab-/NAT- allografts.
A prospective review of all HCV non-viremic LTx recipients transplanted with an HCV Ab+/NAT- organs between 3/2016 and 8/2018 was performed. All HCV Ab+/NAT- organ recipients underwent HCV testing at 3 months and 1-year post-LTx to determine HCV transmission.
55 HCV non-viremic candidates received HCV Ab+/NAT- organs; 64% male, median age 59 years (36-69) and median MELD score of 22.5. Two recipients were excluded due to death prior to HCV testing. HCV disease transmission occurred in 5 recipients (9%). Of these, four (80%) underwent anti-HCV treatment with eradication of virus. No patient found to be negative at 3 months seroconverted at one-year follow-up. No patients who received PHS IRD HCV Ab-/NAT- organs developed viremia (0/57) and there was no difference in graft and renal function, complications or survival between HCV Ab-/NAT- recipients and PHS increased risk HCV Ab-/NAT- recipients.
We 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 to PHS IRD HCV Ab-/NAT- recipients. Due to availability of safe and effective HCV therapies, the use of such organs should strongly be considered to increase the donor organ pool.