Hepatitis C :: Use of Hepatitis C-Infected Donors in Liver Transplantation

To meet the increasing demand for donor livers, researchers are searching for opportunities to utilize non-optimal livers to offer some improvement to severely ill patients.

Some centers are now transplanting livers from hepatitis C (HCV)-infected donors into recipients with HCV-related cirrhosis.

This study compared transplant outcomes for liver recipients from HCV-infected donors to those for standard, non-extended criteria (ECD) donors to determine the possible benefits or consequences of this practice.

Researchers examined 37 recipients of livers and 76 ECD donors. Thirty percent of all donors met non-ECD criteria (standard donors) and were included as potential matches for the case-control study. Each HCV-positive liver donor recipient was matched to two standard donor recipients as matched standard donor controls (MSDC). MSDC were classified by recipient age, primary diagnosis, cancer stage for those with HCC, recipient MELD (Model for End-Stage Liver Disease system used to prioritize waitlist patients) and donor age. Patients were monitored for graft and patient survival at three months, one year and two years; perioperative death; and HCV recurrence by four-month and one-year fibrosis (F0-F4).

In this study, researchers note that when hepatitis C positive donors were used, no difference in survival was observed. However, the rate of fibrosis appeared to be slower in those receiving HCV-infected livers. These preliminary results suggest that HCV-infected liver transplant recipients receiving livers from HCV-infected donors may have a slower rate of fibrosis progression at one year.

“This is a trend we’re seeing in survival advantage for those receiving HCV-donor grafts compared to standard donor controls,” says Paul Kwo, M.D., of Indiana University in Indianapolis, Ind., and lead author of this study. “The use of HCV positive donors may be considered as a first line therapy to increase the available donor pool of organs in those undergoing OLT for HCV-related cirrhosis, which is the most common cause of cirrhosis leading to orthotopic liver transplantation. We hope to further extend this research to understand how we can maximize the use of extended criteria donor organs. This includes hepatitis C positive graft that may benefit HCV-infected individuals who require orthotopic liver transplantation, as well as gain insight as to why these organs may have a slower rate of fibrosis than non-HCV infected donor organs.”


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