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Donor Characteristics and Regional Differences in the Utilization of HCV-Positive Donors in Liver Transplantation
Ben L Da1,2, Ghideon Ezaz1, Tatyana Kushner1
1Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York.
Insights
Hepatitis C virus (HCV)-positive donors are younger and healthier than negative donors, yet their utilization in liver transplants varies significantly by region. Increased use of these donors, especially in high-demand areas, is recommended to address organ shortages.
Area of Science:
- Transplantation immunology
- Hepatology
- Public health
Background:
- National organ shortages necessitate exploring allograft sources, including hepatitis C virus (HCV)-positive donors.
- Characterization of HCV-positive donors and regional utilization patterns is crucial for optimizing liver transplant (LT) strategies.
Purpose of the Study:
- To characterize donors testing positive for HCV (HCV-positive) and their allografts.
- To analyze regional variations in the utilization of HCV-positive liver allografts across the United States.
Main Methods:
- Cross-sectional study querying the Scientific Registry of Transplant Recipients database (June 2015-December 2018).
- Included donors tested for HCV antibody (Ab) and nucleic acid amplification testing (NAT).
- Excluded living donor transplants and pediatric recipients.
Main Results:
- HCV Ab-positive donors (7.7% of 24,500) were younger (median 35 years) and healthier (fewer comorbidities) than HCV Ab-negative donors.
- Significant regional disparities in HCV-positive donor utilization were observed across 11 Organ Procurement and Transplantation Network regions.
- Utilization correlated with opioid epidemic rates in some regions, but not consistently.
Conclusions:
- HCV-positive donors represent a valuable, younger, and healthier donor pool for liver transplantation.
- Substantial regional differences in HCV-positive donor utilization exist, not fully explained by demand or epidemic factors.
- Targeted initiatives are needed to increase HCV-positive donor utilization, particularly in regions with high organ demand.
Importance:
Increased utilization of hepatitis C virus (HCV)-positive liver allografts for liver transplant (LT) has been endorsed as one of several ways to combat national organ shortages. However, HCV-positive donors remain poorly characterized, and Organ Procurement and Transplantation Network regional differences in the utilization of HCV-positive liver allografts are unclear.
Objective:
To characterize HCV-positive donors and the allografts that come from them.
Design, Setting, And Participants:
In this cross-sectional study, the Scientific Registry of Transplant Recipients database was queried for all donors who underwent HCV testing from June 2015 to December 2018. Clinical and allograft characteristics were evaluated, and utilization across the United States was studied. Patients with positive or negative results for HCV antibody (Ab) and HCV nucleic acid amplification testing (NAT) were included in this study. Donors utilized for living donor transplant and pediatric (age <18 years) recipients were excluded.
Main Outcomes And Measures:
The primary comparison was between donors who were HCV Ab positive and those who were HCV Ab negative. Regional variations in the utilization of HCV-positive and HCV-negative donors were analyzed.
Results:
Of 24 500 donors utilized for LT, 1887 (7.7%) were HCV Ab positive; 64.4% of HCV Ab-positive donors were HCV NAT positive. HCV Ab-positive donors were younger (median [interquartile range] age, 35 [29-46] years vs 40 [27-54] years) and had fewer comorbidities, such as diabetes (8.3% vs 12.0%) and hypertension (25.9% vs 35.2%), compared with HCV Ab-negative donors. These findings were even more pronounced in HCV Ab-positive /NAT-positive compared with HCV Ab-positive/NAT-negative donors. Organ Procurement and Transplantation Network regions 2, 3, 10, and 11 had the highest absolute utilization of HCV Ab-positive donors, accounting for 64.4% of all HCV Ab-positive donors used in the United States. Region 1 had the highest relative utilization of HCV Ab-positive donors (18.7%). The use of HCV Ab-positive donors in some regions was associated with the rate of drug overdose, but this was not always the case. Similar utilization results were found with HCV NAT-positive donors.
Conclusions And Relevance:
In this cross-sectional study, HCV-positive donors were younger and healthier than utilized HCV-negative donors. Significant differences exist in the utilization of HCV-positive donors across the 11 Organ Procurement and Transplantation Network regions, which is not entirely explained by organ demand or by higher availability of HCV-positive livers as per the distribution of the opioid epidemic. Initiatives to increase the use of HCV-positive donors, particularly in regions of high organ demand, should be implemented.
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