Use of liver organs from selected hepatitis C positive donors should be considered due to modest risk of hepatitis C transmission and the availability of safe and effective direct‐acting antiviral therapies, according to research presented this week at The Liver Meeting® -; held by the American Association for the Study of Liver Diseases.
Hepatitis C virus, commonly called HCV, is a liver disease that can cause cirrhosis (scarring of the liver), liver cancer and liver failure. HCV is contracted when a person comes in contact with an infected person's blood.
Given the ongoing shortage of liver grafts for transplantation, the use of increased‐risk donor livers (which are positive for HCV antibodies, but do not have evidence of active HCV infection) may be one way of increasing the donor pool and getting more patients off the waitlist. "While HCV‐positive donors (antibody test) with active infection (serum nucleic acid test positive) carry a universal risk of HCV transmission and their use is reserved for patients with active HCV on the transplant wait‐list, we hypothesized that HCV‐ positive donors without active infection will carry a much lower risk of HCV transmission. Liver organs from such donors, sometimes, can be discarded if an HCV positive patient is not available as a recipient. Our study was aimed at evaluating the risk of HCV transmission from such donors to non‐HCV patients on transplant waitlists," says Khurram Bari, MD, assistant professor of Medicine at the University of Cincinnati.
Dr. Bari's team studied a group of 25 patients at the University of Cincinnati who underwent liver transplantation between March 2016 and February 2017. These patients did not test positive for HCV at the time of transplantation. The livers they received during transplantation came from donors who tested positive for HCV antibodies and were labeled as HCV‐positive donors, but tested negative through HCV serum nucleic acid testing – suggesting no active infection. The majority of these donors were determined to be at increased risk for infection transmission by the Public Health Services' (PHS) criteria based on donor characteristics.
All organ recipients underwent HCV testing three months post-transplantation. Of the 25 people in the group, HCV transmission occurred in four (16 percent). Of the four, one recipient had a prior history with HCV/HIV co‐infection and had undergone a successful HCV treatment two years prior to transplantation. Three of the four recipients were treated with direct‐acting antiviral therapy (with one recipient completing 12 weeks of treatment and achieving a favorable outcome and the other two currently undergoing treatment and showing no signs of the virus at weeks two and four). The fourth recipient succumbed to complications brought on by pulmonary hypertension precluding treatment.
The researchers noted that while all donors were assessed to be at increased risk for transmission according to PHS' criterion, the 16 percent rate of transmission was much higher than expected for the interval between infection and the appearance of mature virus in the serum – called the eclipse period. "Although our study did not look at the specific mode of HCV transmission, occult hepatitis C in donors could be one of the possible mechanisms," says Dr. Bari of the findings. "Our study, as a first-ever, has estimated the actual risk of HCV transmission to non‐HCV patients from the use of liver grafts from serum HCV antibody positive, but nucleic acid test negative donors, "continues Dr. Bari. "Combined with the modest risk of transmission and positive response to DAA treatment, use of such organs could be considered to expand the donor pool. Future studies should be aimed at determining the exact mechanism of HCV transmission from such organs so that risk of transmission can be further reduced and widespread use of these organs can be made possible."