New Data Endorse Use of Hepatitis C-Positive Liver Donors

Kate Johnson

April 17, 2016

BARCELONA, Spain — For patients infected with hepatitis C who are on the transplant list, a hepatitis C–positive donor liver "could be reasonably safe option," a new study suggests.

However, although there was no association between donor hepatitis C status and mortality or graft survival, "our data cannot be used in support of indiscriminate use of hepatitis C–positive donors," said lead investigator Maria Stepanova, PhD, from the Center for Outcomes Research in Liver Diseases in Washington, DC.

The findings, presented here at the International Liver Congress 2016, are timely, given that the shortage of organs has led to increasing use of "theoretically suboptimal" donors, said senior investigator Zobair Younossi, MD, from the Center for Liver Diseases in Falls Church, Virginia.

Despite a more than 90% cure rate for patients with hepatitis C, thanks in large part to direct-acting antiviral therapy, the transplantation of hepatitis C–positive organs into hepatitis C–negative recipients is still not a reasonable consideration, he explained.

"The evidence is not there," Dr Younossi said during a news conference. "You can cause severe and acute hepatitis in an immunosuppressed hepatitis C–negative individual undergoing transplant."

In contrast, the use of positive donors for positive recipients has tripled in the past 2 decades, from 3% in 1995 to more than 9% in 2013, Dr Stepanova reported.

For their study, the investigators identified 33,668 hepatitis C–positive patients who underwent liver transplantation from 1995 to 2013. Of these, 1930 patients (5.7%) received a hepatitis C–positive donor liver.

Mortality and graft loss were similar for patients who received a positive liver and those who received a negative liver (P > .05 for all).

In fact, year of transplantation was the only predictor of outcome. Specifically, the more recent the transplantation, the lower the rates of mortality (adjusted hazard ratio [HR], 0.978; < .0001) and graft loss (adjusted HR, 0.960; P < .0001).

Table. Outcomes After Liver Transplantation With a Hepatitis C–Positive Donor

Year After Transplant Mortality, % Graft Loss, %
1 12.5 2.2
3 24.2 4.8
5 33.0 7.5
10 47.5 13.9

 

Positive donors were less likely than negative donors to be heart-beating at the time of procurement (1.6% vs 3.6%; P < .0001), and more likely to have had liver cancer (28% vs 23%; P < .0001), "which we believe suggests that there should be a more cautious use of such organs," said Dr Stepanova.

"Further studies are needed to establish evidence-based selection criteria for hepatitis C–positive donors that will provide patients with the best possible risk-to-benefit ratio," she explained.

"The transplant community is always excited to encounter studies that support the potential to expand the donor pool," said John LaMattina, MD, director of the living donor liver transplant program at the University of Maryland Medical Center in Baltimore.

The work is "consistent with our own center's internal data that show that the use of a liver from a hepatitis C–positive donor with a healthy liver biopsy leads to excellent results, and can shorten the waitlist time for hepatitis C–positive recipients," Dr LaMattina told Medscape Medical News.

Dr Stepanova has disclosed no relevant financial relationships. Dr Younossi reports serving as a consultant for BMS, AbbVie, Gilead, GSK, and Intercept.

International Liver Congress (ILC) 2016: Abstract PS040. Presented April 14, 2016.

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