- 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.
- 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 (<50 years), be they HCV+ or HCV–.
- 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.
- 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