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A Protocol for Analyzing Hepatitis C Virus Replication
Published on: June 26, 2014
OPTN/SRTR 2018 Annual Data Report: Hepatitis C
J H Wang1, S K Gustafson2, M A Skeans2
1Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN.
Insights
Direct acting antivirals (DAAs) enable the use of hepatitis C virus (HCV)-infected organs for transplantation. While short-term outcomes are promising, long-term allograft survival requires further investigation.
Area of Science:
- Transplantation immunology
- Infectious disease
- Organ transplantation
Background:
- Direct acting antivirals (DAAs) have revolutionized hepatitis C virus (HCV) treatment.
- DAAs offer high cure rates post-transplant, increasing interest in HCV-positive donor organs.
- This has led to increased transplantation of organs from HCV-positive donors into both HCV-infected and uninfected recipients.
Purpose of the Study:
- To examine trends in HCV-positive donor transplants from 2007 to 2018 across various organ types.
- To analyze changes in willingness to accept HCV-positive organs among transplant candidates.
- To assess short-term and long-term allograft survival rates for recipients of HCV-positive organs.
Main Methods:
- Analysis of transplant data from 2007 to 2018.
- Examination of trends in organ acceptance and transplant numbers.
- Comparison of allograft survival rates between recipients of HCV-positive and HCV-negative donor organs.
Main Results:
- Willingness to accept HCV-positive organs increased for kidney, lung, heart, and pancreas transplants since 2015.
- Willingness decreased for intestine transplants and initially for liver transplants, with a recent increase.
- Numbers of HCV-positive donor kidney, heart, lung, and liver transplants have risen significantly.
- Short-term allograft survival for kidney and liver transplants using HCV-positive organs appears comparable to those using HCV-negative organs.
- Unadjusted analysis suggests potentially worse long-term allograft survival for HCV-positive donor organs.
- Emerging data on kidney transplants from HCV-infected donors to uninfected recipients with DAA treatment show promising short-term survival.
Conclusions:
- The use of HCV-positive donor organs is increasing, driven by DAA advancements.
- Short-term allograft survival is comparable, but long-term outcomes require further study.
- Kidney transplantation from HCV-infected donors to uninfected recipients with post-transplant DAA treatment is a promising area needing long-term monitoring.
Abstract:
Direct acting antivirals (DAAs) have fundamentally changed the treatment of hepatitis C virus (HCV) infection and reduced the discard rate of HCV-infected organs by offering a treatment option with a high likelihood of cure posttransplant. This has spurred increased interest in transplanting organs from HCV-positive donors into recipients both with and without HCV. In this chapter, we examine data from 2007 to 2018 to determine trends in HCV (+) donor transplants across various organ types. Since 2015, willingness to accept HCV (+) organs increased for candidates waitlisted for kidney, lung, heart, and pancreas transplant, but decreased for those listed for intestine transplant. For candidates listed for liver transplant, willingness to accept HCV (+) organs decreased from 2007 to 2017, but began increasing in 2017. Willingness to accept was not concentrated in a single US geographic area, and there was substantial variation among transplant programs and donation service areas. Numbers of anti-HCV (+) donor kidney, heart, lung, and liver transplants have increased considerably in the past few years. Short-term allograft survival for kidney and liver transplant recipients of anti-HCV (+) organs appears to be comparable to that for recipients of anti-HCV (-) organs in an unadjusted analysis. However, an unadjusted analysis indicates that long-term allograft survival may be worse. Kidney transplant between HCV-infected donors and uninfected recipients with posttransplant DAA treatment is an emerging area. Short-term data are promising, with similar 1-year allograft survival compared with HCV-uninfected donor to HCV-uninfected recipient kidney transplants in unadjusted analyses. However, long-term data are lacking and close monitoring in the future is warranted.
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