Summary
Should organs from hepatitis C antibody positive donors (HCVD+) be used for transplantation?
Organ shortage forces transplant teams to use donors with extended criteria. The decision
to transplant a HCVD+ graft is a balance between the risk of transmission of a virus
that could lead to end-stage liver diseases and the benefit of access to transplantation,
specifically in patients with life-threatening disease. The other issue is the impact
of HCV-related liver fibrosis in the donor graft on the long-term outcome in the recipient.
Thus, the use of HCVD+ demonstrated a shorter meantime on the waiting list in kidney
transplantation. When a HCVD+ graft is transplanted, the risk of HCV transmission
depends on; 1) the quality of screening of the donor; 2) the presence of viral replication
in the donor at the time of transplantation and the ability to detect it; and 3) the
HCV status of the recipient but also the type of transplanted organ. In liver transplantation,
the use of HCVD+ graft is usually restricted to recipients with a chronic HCV infection.
Several reports showed some competition between HCV donor and recipient strain without
deleterious impact on graft and patient survival. Controversies are still pending
regarding the quality of the graft and the progression of fibrosis. The recent approval
of direct-acting antiviral agents (DAA) dramatically changes the landscape of HCV
infection treatment. After transplantation, combinations of DAA show high efficacy
and good safety profile. In the near future, extensive use of DAA should reduce the
number of HCVD+ with a positive HCV RNA, limiting the risk of transmission but also
the number of patients on waiting lists for a disease related to HCV.
Keywords
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Article info
Publication history
Published online: September 12, 2015
Accepted:
September 4,
2015
Received in revised form:
August 26,
2015
Received:
July 15,
2015
Identification
Copyright
© 2015 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.
