- A newly released consensus report supports use of transplanting organs from HCV viremic donors into many HCV-negative liver and kidney recipients.
- Report was developed to address increasing numbers of younger, opioid overdose brain-dead HCV viremic donors but is broadly applicable.
Why this matters
- Educate all potential recipients of risks, benefits associated with HCV viremic organs in transplantations.
- Offer current candidates an opportunity to begin direct-acting antiviral (DAA) to potentially prevent or modify subsequent morbidity.
- DAA treatment cures >95% of acute donor-derived HCV infection, supporting transplanting HCV viremic organs into HCV-negative recipients (as long as rigorous consent is obtained).
- Access to preemptive pangenotypic DAA treatment is recommended in all liver, kidney recipients to reduce graft injury, chronic infection.
- Carefully assess all medications for drug-drug interactions with DAA drugs.
- Risk of HCV viremic transplantation should be weighed against risk of remaining on the transplant waiting list.
- Risk of viral resistance-related allograft failure is low; consider transplantation in recipients failing DAA therapies.
- Consider pretransplant liver biopsy in older donors aged ≥35 years to exclude advanced fibrosis; donor livers with Metavir >2 fibrosis (F)0-2 are acceptable for transplantation.