Direct-Acting Antivirals and Organ Transplantation: Is There Anything We Can't Do?

Area of Science:

• Hepatology
• Transplant Surgery
• Infectious Diseases

Background:

• The opioid epidemic has increased hepatitis C virus (HCV) infected organ donors in the US.
• Direct-acting antiviral (DAA) regimens now offer high sustained virologic response rates, even post-transplant.
• HCV-viremic organs are increasingly utilized for transplant candidates, regardless of prior HCV status.

Purpose of the Study:

• To review the use of HCV-viremic organs in solid organ transplantation.
• To discuss current HCV treatment strategies, adverse events, and ethical considerations.
• To highlight the impact of effective HCV therapies on transplant accessibility and patient survival.

Main Methods:

• Review of key studies involving solid organ transplants using HCV-viremic organs.
• Analysis of recent reports on adverse events associated with these transplants.
• Examination of ethical and regulatory aspects of utilizing HCV-viremic organs.

Main Results:

• Direct-acting antiviral therapies demonstrate high efficacy in treating HCV post-transplantation.
• Utilizing HCV-viremic organs expands donor pool and transplant opportunities.
• Delayed and preemptive treatment strategies are employed for HCV management.

Conclusions:

• Effective HCV therapies enable the safe use of HCV-viremic organs, improving transplant outcomes.
• This approach increases access to transplantation and reduces mortality for end-stage organ failure patients.
• Careful consideration of treatment strategies, adverse events, and regulations is crucial for successful implementation.