EASL 2018 – Transplantation of HCV+ organs


  • HCV Conference Roundups
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Takeaway

  • In the era of effective direct-acting antiviral (DAA) treatment, transplantation of HCV+ organs has dramatically increased and demonstrated safety and efficacy as a therapeutic option.
  • Use of HCV+ organs can expand the donor pool and reduce time to transplant.

Why this matters

  • While demand for organs rises, there is an unprecedented increase in HCV+ donors. This may be explained by an increased ability to effectively treat HCV infection in the transplant setting.

Key points

  • The percentage of HCV+ donors has nearly doubled following the highly effective use of DAAs; overall rate of sustained virologic response at 12 weeks posttherapy (SVR12) is over 97% with newer agents.
  • Most studies report excellent outcome with HCV+ graft utilization in both HCV+ and HCV– recipients.
  • HCV+ donors potentially represent an ideally young and comorbidity-free donor source.
  • Survival is improved in patients receiving graft from younger donors (
  • Use of HCV+ donors reduces time on the waiting-list (50% reduction) and waitlist mortality.
  • HCV DAA options for transplant recipients are highly effective, except in decompensated graft cirrhosis.

Limitations

  • Transplanting an HCV-RNA+ organ represents a 100% transmission risk: attribution criteria still need to be clarified
  • DAA cost and access to DAAs may limit HCV+ organ transplantation