No Risk of Worse Outcomes in Liver Transplantation With Hepatitis C-Positive Organs

Source: DGNews 

Presented at CEOT

By Nancy A. Melville

CHANDLER, Arizona -- February 18, 2014 -- The use of organs positive for hepatitis C virus (HCV) carries no increased risk of poorer outcomes among recipients who are also positive for HCV, according to research presented here at the American Society of Transplantation’s 2nd Annual Cutting Edge of Transplantation (CEOT) Meeting.

“Using the United Network for Organ Sharing (UNOS) and Scientific Registry of Transplant Recipients databases, we were able to demonstrate that since the introduction of the new organ allocation system in 2002 [Model for End-Stage Liver Disease or MELD system], HCV-positive recipients and the HCV serostatus of the donor do not have any impact on overall patient or graft survival,” said Martin Montenovo, MD, University of Washington, Seattle, Washington, on February 14.

For the study, Dr. Montenovo and colleagues evaluated 59,899 liver-transplant recipients aged ≥18 years in the UNOS database from 2002 to 2013.

Among the patients, 1,695 (2.8%) were HCV-positive recipients who had received HCV-positive allografts.

An analysis of differences in patient characteristics between recipients of HCV-positive and HCV-negative organs, as well as graft survival, showed that HCV-positive patients who received HCV-negative grafts were more likely to be hospitalised, in the intensive care unit, and on a ventilator and to have higher MELD scores and higher bilirubin.

Whereas patient and graft survival rates at 1, 5, and 10 years among HCV-positive recipients were inferior to HCV-negative recipients, there were no survival differences between HCV-positive patients who received HCV-positive or HCV-negative grafts.

“As far as we know, this is the first report looking at the effect of HCV donor status on HCV-positive recipients since the introduction of the MELD system,” Dr. Montenovo said. “All previous studies have shown some disparities in the results regarding the impact of the HCV donor status on patient and graft survival.”

The findings offer important evidence that the use of HCV-positive organs does not necessarily compromise outcomes, added Dr. Montenovo .

“The utilisation rate of this pool of donors has not changed over the years since the introduction of the MELD score allocation system,” he said.

“With the increasing number of HCV-positive recipients waiting for an organ in an era of significant organ shortage, more interest should be placed on HCV-positive donors who are often disregarded due to concerns of long-term outcomes,” Dr. Montenovo concluded. “Further large studies are needed to assess the impact, if any, of HCV-RNA donor status on outcomes.”

[Presentation title: The Clinical Impact of Hepatitis C-Positive Donors in Liver Transplantation: Patient Protection or Lost Opportunities? Abstract P-27]

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