Abstract
Direct acting antivirals (DAAs) have fundamentally changed the treatment of hepatitis C virus (HCV) infection and reduced the discard rate of HCV-infected organs by offering a treatment option with a high likelihood of cure posttransplant. This has spurred increased interest in transplanting organs from HCV-positive donors into recipients both with and without HCV. In this chapter, we examine data from 2007 to 2018 to determine trends in HCV (+) donor transplants across various organ types. Since 2015, willingness to accept HCV (+) organs increased for candidates waitlisted for kidney, lung, heart, and pancreas transplant, but decreased for those listed for intestine transplant. For candidates listed for liver transplant, willingness to accept HCV (+) organs decreased from 2007 to 2017, but began increasing in 2017. Willingness to accept was not concentrated in a single US geographic area, and there was substantial variation among transplant programs and donation service areas. Numbers of anti-HCV (+) donor kidney, heart, lung, and liver transplants have increased considerably in the past few years. Short-term allograft survival for kidney and liver transplant recipients of anti-HCV (+) organs appears to be comparable to that for recipients of anti-HCV (-) organs in an unadjusted analysis. However, an unadjusted analysis indicates that long-term allograft survival may be worse. Kidney transplant between HCV-infected donors and uninfected recipients with posttransplant DAA treatment is an emerging area. Short-term data are promising, with similar 1-year allograft survival compared with HCV-uninfected donor to HCV-uninfected recipient kidney transplants in unadjusted analyses. However, long-term data are lacking and close monitoring in the future is warranted.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 542-568 |
| Number of pages | 27 |
| Journal | American Journal of Transplantation |
| Volume | 20 |
| Issue number | s1 |
| DOIs | |
| State | Published - Jan 1 2020 |
Bibliographical note
Funding Information:In the past few years, waitlisted candidates across all organ types except intestine have been more willing to accept organs from anti‐HCV (+) donors, and use of anti‐HCV (+) donors has increased across kidney, heart, lung, and liver transplant. Both of these observations are likely due to the increasing availability of DAAs, which have been shown to be highly effective in curing HCV infection. Short‐term kidney and liver allograft survival in recipients of anti‐HCV (+) organs is similar to that in recipients of anti‐HCV (‐) organs in unadjusted analyses. While long‐term HCV (+) allograft outcomes are yet to be determined, increasing use of these organs, including NAT (+) organs, increases the pool of available organs and improves access for all candidates awaiting a life‐saving transplant. The publication was produced for the U.S. Department of Health and Human Services, Health Resources and Services Administration, by the Hennepin Healthcare Research Institute (HHRI) and by the United Network for Organ Sharing (UNOS) under contracts HHSH250201500009C and 234‐2005‐37011C, respectively. This publication lists non‐federal resources in order to provide additional information to consumers. The views and content in these resources have not been formally approved by the U.S. Department of Health and Human Services (HHS) or the Health Resources and Services Administration (HRSA). Neither HHS nor HRSA endorses the products or services of the listed resources. OPTN/SRTR 2018 Annual Data Report is not copyrighted. Readers are free to duplicate and use all or part of the information contained in this publication. Data are not copyrighted and may be used without permission if appropriate citation information is provided. Pursuant to 42 U.S.C. §1320b‐10, this publication may not be reproduced, reprinted, or redistributed for a fee without specific written authorization from HHS. Suggested Citations Full citation: Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR). OPTN/SRTR 2018 Annual Data Report. Rockville, MD: Department of Health and Human Services, Health Resources and Services Administration; 2019. Abbreviated citation: OPTN/SRTR 2018 Annual Data Report. HHS/HRSA. Publications based on data in this report or supplied on request must include a citation and the following statement: The data and analyses reported in the 2018 Annual Data Report of the U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients have been supplied by the United Network for Organ Sharing and the Hennepin Health‐care Research Institute under contract with HHS/HRSA. The authors alone are responsible for reporting and interpreting these data; the views expressed herein are those of the authors and not necessarily those of the U.S. Government. This report is available at srtr.transplant.hrsa.gov. Individual chapters, as well as the report as a whole, may be downloaded.
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