Expanding access to transplantation with hepatitis C-positive donors: A new perspective on an old issue

Area of Science:

• Hepatology
• Transplantation Medicine
• Virology

Background:

• Organ shortages necessitate considering donors with prior viral infections like hepatitis B (HBV) and hepatitis C (HCV).
• Direct-acting antivirals (DAAs) have revolutionized HCV treatment, impacting organ transplantation protocols.
• Existing protocols often address HBV core antibody-positive (HBcAb+) donors, but HCV donor utilization requires updated strategies.

Purpose of the Study:

• To provide guidance on utilizing organs from hepatitis C virus (HCV)-positive donors for transplantation.
• To evaluate the risks and benefits of transplanting organs from HCV antibody-positive (HCVAb+) and nucleic acid testing negative (HCV NAT-) donors.
• To highlight the potential of using organs from HCV NAT-positive donors given the efficacy of DAAs.

Main Methods:

• Review of current transplantation protocols and literature regarding viral-positive donors.
• Analysis of HCV transmission rates based on antibody and nucleic acid testing status.
• Consideration of direct-acting antiviral (DAA) efficacy in post-transplant recipients.

Main Results:

• HCV transmission from HCVAb+, HCV NAT- donors is low, making these organs viable for HCV recipients with proper precautions.
• HCV transmission from HCV NAT+ donors is universal but manageable with DAAs, leading to sustained viral response.
• Successful transplantation outcomes are achievable with careful donor selection, recipient counseling, and post-transplant monitoring.

Conclusions:

• Organs from HCV-positive donors, particularly HCVAb+, HCV NAT- donors, should be considered for transplantation to address organ shortages.
• The advent of DAAs significantly improves the safety and efficacy of transplanting organs from HCV NAT+ donors.
• Implementing updated protocols for HCV-positive donors can expand the donor pool and improve patient survival rates.