Allowing the transplantation of livers from donors with hepatitis C virus (HCV) into those who do not have the virus is feasible and would not be associated with undue risk given the effectiveness of direct-acting antiviral (DAA) treatment for the virus. Those who received a hep C–positive liver could be effectively treated with DAAs, which have a high cure rate.
HCV-positive organs are often discarded because of risks associated with transplanting them into HCV-negative individuals.
The availability of highly effective DAAs has reduced the number of infected organs in the overall transplantation pool. Meanwhile, the opioid epidemic has had an opposite effect, leading young and healthy people to contract hep C and ultimtaely increasing the number of infected organs available for transplant.
Publishing their findings in the journal Hepatology, researchers conducted a modeling study in which they ran a clinical trial virtually, simulating the life courses of HCV-negative individuals on the waiting list for a new liver. The study authors compared expected outcomes under a pair of scenarios, including having the individuals wait for an HCV-negative liver or having them receive any appropriate liver and then receive DAA treatment should their donor have hep C.
The model considered various factors, including the time the individuals would likely wait for an available liver based on the severity of their own liver disease and the region of the country in which they live; each region’s supply of transplantable livers; the risk of complications from receiving an HCV-positive liver; and the efficacy of receiving DAA treatment after a transplant.
The study authors concluded that for most HCV-negative people on the liver transplant waiting list, the benefits outweighed the risks involved with having them receive HCV-positive livers. The extent of the benefits depended on the severity of their liver disease, according to the MELD scoring system. Those with a score of 20 or greater could benefit from receiving such a liver. The benefits would be greatest for those with a score of 28 and those in regions hard-hit by the opioid epidemic, including the Northeast, where there are higher numbers of HCV-positive donors.
To read a press release about the study, click here.
To read the study abstract, click here.