Hepatitis C-positive liver transplantation: outcomes and current practice

Area of Science:

• Hepatology
• Transplantation Medicine
• Infectious Diseases

Background:

• The opioid epidemic and direct-acting antiviral (DAA) availability created an imbalance of hepatitis C virus (HCV)-viremic donors versus patients needing liver transplants.
• Transplantation of HCV-positive donor livers into HCV-negative recipients has risen despite ethical considerations regarding intentional HCV infection.
• This review examines outcomes, cost-effectiveness, and ethics of using HCV-positive donor livers for HCV-negative recipients.

Purpose of the Study:

• To review the outcomes, cost-effectiveness, and ethical implications of transplanting HCV-positive liver allografts into HCV-negative recipients.
• To assess patient and graft survival, complication rates, and the impact of DAAs on treatment success.
• To evaluate the ethical considerations surrounding the use of HCV-viremic organs in a context of organ scarcity.

Main Methods:

• Systematic review of current literature on HCV-positive to HCV-negative liver transplantation.
• Analysis of patient and graft survival data, rejection rates, and post-transplant complications.
• Evaluation of cost-effectiveness models and ethical arguments regarding organ allocation.

Main Results:

• Patient and graft survival rates are comparable to those receiving HCV-negative allografts.
• No significant increase in acute rejection or vascular/biliary complications observed.
• HCV-related complications (e.g., fibrosing cholestatic hepatitis) are rare, reversible with DAAs, and treatment failure is infrequent.
• Transplantation is cost-effective, with modeling suggesting a survival benefit for recipients accepting HCV-positive organs.
• Ethical arguments suggest withholding HCV-positive organs may be unethical given informed consent and potential survival benefits.

Conclusions:

• Transplantation of HCV-positive donor livers into HCV-negative recipients demonstrates favorable short-term outcomes and is cost-effective.
• Prompt treatment with direct-acting antivirals effectively manages HCV infection post-transplant, minimizing severe complications.
• The practice is ethically justifiable, particularly with informed consent, given the organ shortage and potential survival advantages.