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Am J Transplant. 2017 Feb;17(2):519-527. doi: 10.1111/ajt.13976. Epub 2016 Aug 24.

Changes in Utilization and Discard of Hepatitis C-Infected Donor Livers in the Recent Era.

Author information

1
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
2
Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
3
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
4
Department of Epidemiology and Biostatistics, George Washington University School of Public Health, Washington, DC.
5
Scientific Registry of Transplant Recipients, Minneapolis, MN.

Abstract

The impact of interferon (IFN)-free direct-acting antiviral (DAA) hepatitis C virus (HCV) treatments on utilization and outcomes associated with HCV-positive deceased donor liver transplantation (DDLT) is largely unknown. Using the Scientific Registry of Transplant Recipients, we identified 25 566 HCV-positive DDLT recipients from 2005 to 2015 and compared practices according to the introduction of DAA therapies using modified Poisson regression. The proportion of HCV-positive recipients who received HCV-positive livers increased from 6.9% in 2010 to 16.9% in 2015. HCV-positive recipients were 61% more likely to receive an HCV-positive liver after 2010 (early DAA/IFN era) (aRR:1.45 1.611.79 , p < 0.001) and almost three times more likely to receive one after 2013 (IFN-free DAA era) (aRR:2.58 2.853.16 , p < 0.001). Compared to HCV-negative livers, HCV-positive livers were 3 times more likely to be discarded from 2005 to 2010 (aRR:2.69 2.993.34 , p < 0.001), 2.2 times more likely after 2010 (aRR:1.80 2.162.58 , p < 0.001) and 1.7 times more likely after 2013 (aRR:1.37 1.682.04 , p < 0.001). Donor HCV status was not associated with increased risk of all-cause graft loss (p = 0.1), and this did not change over time (p = 0.8). Use of HCV-positive livers has increased dramatically, coinciding with the advent of DAAs. However, the discard rate remains nearly double that of HCV-negative livers. Further optimization of HCV-positive liver utilization is necessary to improve access for all candidates.

KEYWORDS:

clinical research/practice; donors and donation: deceased; infection and infectious agents; infectious disease; liver transplantation/hepatology; viral: hepatitis C

PMID:
27456927
PMCID:
PMC5266634
DOI:
10.1111/ajt.13976
[Indexed for MEDLINE]
Free PMC Article

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