Hepatitis C viraemic organs in solid organ transplantation

J Hepatol. 2021 Mar;74(3):716-733. doi: 10.1016/j.jhep.2020.11.014. Epub 2020 Nov 16.

Abstract

Although rates of organ donation and solid organ transplantation have been increasing over the last few decades, demand for organs still greatly exceeds supply. Several strategies have been utilised to increase organ supply, including utilisation of high-risk (e.g. HCV antibody-positive) donors. In this context, organs from HCV antibody-positive donors have been used in recipients with chronic HCV since the early 1990s. Recently, transplantation of HCV-viraemic organs into HCV-naïve recipients has garnered significant interest, owing to the development of safe and highly effective direct-acting antivirals and increased experience of treating HCV in the post-transplant setting. Preliminary studies based largely in the US have shown excellent outcomes in kidney, liver, heart, and lung transplantation. This practice has the potential to significantly increase transplantation rates and decrease waitlist mortality; however, intentionally transmitting an infectious disease to recipients has important practical and ethical implications. Further, the generalisability of the US experience to other countries is limited by significant differences in HCV-viraemic donor populations. This review summarises the current data on this practice, discusses barriers to implementation, and highlights areas that warrant further study.

Keywords: HCV; HCV-Positive donor; Hepatitis C virus; NAT; Solid organ transplantation; Viremia.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Antiviral Agents / therapeutic use
  • Hepacivirus*
  • Hepatitis C, Chronic / blood
  • Hepatitis C, Chronic / drug therapy
  • Hepatitis C, Chronic / epidemiology*
  • Hepatitis C, Chronic / virology
  • Humans
  • Organ Transplantation / methods*
  • Tissue Donors*
  • Tissue and Organ Procurement / methods*
  • Transplant Recipients*
  • Transplants*
  • Treatment Outcome
  • United States / epidemiology
  • Viremia / epidemiology*
  • Waiting Lists

Substances

  • Antiviral Agents