Long-Term Follow Up of Solid Organ Transplantation Using Hepatitis C Virus Positive Donor for Hepatitis C Virus Negative Recipients

Author Type(s)

Faculty, Resident/Fellow

Document Type

Abstract

Publication Date

2022

DOI

10.1111/ajt.17073

Journal Title

American Journal of Transplantation

Department

Surgery

Second Department

Medicine

Abstract

Purpose: To determine the effects of transplanting an HCV + solid organ to an uninfected patient who is on the transplant waiting list. Outcomes include patient survival, HCV infection, HCV cure rates after antiviral treatment, and infectionrelated complications. Methods: A retrospective cohort of all solid organ transplants in a single center from HCV + donors (HCV-antibody + and/or HCV- NAT +) to HCV - recipients between July 2017 and December 2020. All recipients received 12 weeks of post-transplant antiviral treatment if HCV-RNA became detectable. Results: A total of 56 transplants (N=56) from HCV + donors to HCV - recipients were performed at our center between July 2017 and December 2020. The mean age of the recipients was 55.9 years (range 27 to 79 years). Transplanted organs comprise heart (N=11), combined heart/kidney (N=4), kidney (N=21), liver (N=16), and combined liver/kidney (N=4). HCV donor serology consisted of 64.3% HCV-Ab +/HCV-NAT + (N=36), 26.7% HCV-Ab +/HCV-NAT - (N=15), and 8.9% HCV-Ab -/HCV-NAT + (N=5). 97.2% of the recipients receiving an HCV-Ab +/HCV-NAT + organ converted to HCV-NAT + (N=35). Conversion rates for recipients receiving HCV-Ab +/HCV-NAT - was 13.3% (N=2) and for recipients receiving HCV-Ab -/ HCV-NAT + was 40% (N=2). For the recipients in which HCV-RNA became detectable post-transplant (N=39), 12 weeks of antiviral treatment were initiated and all HCV + recipients were cured after antiviral treatment. 1 patient had a recurrence of HCV, which was cured after the second course of treatment. Total patient survival was 89.3%. A total of 6 patients (N=6) died, 3 in HCV-Ab +/HCV-NAT + group, 2 in HCV-Ab +/HCV-NAT - group, and 1 in HCV-Ab -/HCV-NAT +. Conclusions: Transplants from HCV + donors to HCV - recipients appear safe, and antiviral treatment was effective. Although 100% of HCV-Ab +/HCV-NAT + organ recipients, 40% of HCV-Ab -/HCV-NAT + organ recipients, and 13.3% of HCV-Ab +/HCV-NAT- organ developed HCV viremia, the cure rate was 100% for those who completed the antiviral treatment. Of note, although the conversion rate for HCV-Ab +/HCV-NAT- organ recipients is significantly lower compared to HCV-NAT+ organ recipients, there remains significant risk similar to previously published data and therefore must continue to be monitored.

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