Despite Hepatitis C Virus Status, Many Positive Liver Allograft Donors Were Healthier and Younger

Hepatitis C virus (HCV)-positive liver allograft donors tended to be younger and healthier than HCV-negative donors; results from a cross-sectional study published in JAMA Network Open indicated the use of these HCV-positive allografts, when demand for tissue is high, may be prudent.

Deceased liver transplant (LT) donors (N=24,500) were assessed by HCV nucleic acid amplification testing (NAT) and for HCV antibodies between 2015 and 2018 in the United States. Tissue characteristics were compared between positive and negative samples.

During the study period, 7.7% of the LT were HCV antibody positive and 5.2% were HCV NAT positive. Most positive tissues had cleared infections; only 0.3% had acute HCV infection. Over time, there was a trend for the volume of HCV-positive tissue to increase but for the use of positive donor tissue to decrease.

The HCV-positive LT donors were younger (median, 35 vs 40 years; P <.001), less likely to have hypertension (25.9% vs 35.2%; P <.001) or diabetes (8.3% vs 12.0%; P <.001), and more likely to be White (81.0% vs 63.2%; P <.001). Death was more likely to be caused by overdose (51.7%) among HCV-positive donors than among HCV-negative donors (11.1%; P <.001).

Biopsy specimens of these livers indicated HCV-positive livers were less likely to have macrovesicular (53.0% vs 63.1%; P <.001) and microvesicular (52.9% vs 58.3%; P =.001) steatosis, as well as to have a lower median donor risk index (1.2 vs 1.4; P <.001).

The use of positive donors varied across the country: region 1 (Maine, Vermont, New Hampshire, Massachusetts, Rhode Island, and Connecticut) had the highest use (15.8%), followed by region 2 (New Jersey, Pennsylvania, Maryland, Delaware, and West Virginia; 13.4%), and region 10 (Michigan, Indiana, and Ohio; 11.6%). Region 4 (Texas and Oklahoma) reported the lowest use of positive donors (3.8%).

Deaths due to overdose tended to be higher in regions where HCV-positive tissue was more commonly transplanted (region 1: 25.7% of deaths) compared with less common (region 4: 4.8% of deaths).

This study was limited by not assessing the outcome of HCV-positive liver allografts.

The study authors concluded that although some LTs were positive for HCV antibodies and/or NAT, these tissues tended to be from younger and healthier donors than HCV-negative tissues and therefore may be better candidates for transplantation. To address the decreasing use of these HCV-positive tissues, lowering the stigma of using these organs for transplant through education may increase utilization.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of authors’ disclosures.

Reference

Da BL, Ezaz G, Kushner T, et al. Donor characteristics and regional differences in the utilization of HCV-positive donors in liver transplantation. JAMA Netw Open. 2020;3(12):e2027551. doi:10.1001/jamanetworkopen.2020.27551