Hepatitis C viraemic organs in solid organ transplantation

Area of Science:

• Transplantation immunology
• Infectious diseases
• Hepatology

Background:

• Organ donation and transplantation face a persistent gap between demand and supply.
• Utilizing organs from high-risk donors, such as those positive for Hepatitis C virus (HCV) antibodies, is a strategy to increase organ availability.
• Historically, HCV-positive organs were transplanted into recipients already infected with chronic HCV.

Purpose of the Study:

• To review current data on transplanting HCV-viremic organs into HCV-naïve recipients.
• To discuss the practical and ethical implications of intentionally transmitting an infectious disease.
• To identify barriers and areas for future research in this transplantation strategy.

Main Methods:

• Review of existing literature and preliminary studies on HCV-viremic organ transplantation into HCV-naïve recipients.
• Analysis of outcomes in kidney, liver, heart, and lung transplantation.
• Consideration of the impact of direct-acting antivirals (DAAs) and post-transplant HCV treatment.

Main Results:

• Preliminary studies, primarily from the US, indicate excellent outcomes in various solid organ transplantations using HCV-viremic organs.
• This approach has the potential to significantly increase transplantation rates and reduce mortality on waitlists.
• Effective treatments with direct-acting antivirals (DAAs) have made transplantation of HCV-viremic organs into HCV-naïve recipients a viable option.

Conclusions:

• Transplantation of HCV-viremic organs into HCV-naïve recipients is a promising strategy to expand the donor pool.
• Significant ethical and practical challenges exist, including the intentional transmission of an infectious disease.
• Generalizability of current findings is limited by differences in HCV-viremic donor populations globally, necessitating further study.