Hepatitis C transmission from seropositive, nonviremic donors to non–hepatitis C liver transplant recipients

摘要

Breakthroughs in hepatitis C virus (HCV) treatment and rising rates of intravenous drug use have led to an increase in the number of organ donors who are HCV antibody–positive but serum nucleic acid test (NAT)–negative. The risk of HCV transmission from the liver grafts of these donors to recipients is unknown. To estimate the incidence of HCV transmission, we prospectively followed 26 consecutive HCV antibody–negative (n = 25) or NAT‐negative (n = 1) transplant recipients who received a liver graft from donors who were HCV antibody–positive but serum NAT‐negative between March 2016 and March 2017. HCV transmission was considered to have occurred if recipients exhibited a positive HCV PCR test by 3 months following transplantation. Drug overdose was listed as the cause of death in 15 (60%) of the donors. One recipient died 18 days after transplantation from primary graft nonfunction and was excluded. Of the remaining 25 recipients, HCV transmission occurred in 4 (16%), at a median follow‐up of 11 months, all from donors who died of drug overdose. Three of these patients were treated with direct‐acting antiviral therapy, with two achieving a sustained virologic response and one an end‐of‐treatment response. One patient with HCV transmission died after a complicated postoperative course and did not receive antiviral therapy. Conclusion: In this prospective cohort of non‐HCV liver recipients receiving grafts from HCV antibody–positive/NAT‐negative donors, the incidence of HCV transmission was 16%, with the highest risk conferred by donors who died of drug overdose; given the availability of safe and highly effective antiviral therapies, use of such organs could be considered to expand the donor pool. (H epatology 2018;67:1673‐1682).