Outcomes following transplantation of HCV-seropositive livers to HCV-seronegative recipients.

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Grafts from hepatitis C virus (HCV)-seropositive donors can now be considered for liver transplant (LT) due to the advent of direct-acting antiviral agents (DAA). We report our multicenter experience evaluating the use of HCV-seropositive donors to HCV-seronegative recipients LT.This is a prospective multicenter observational study to evaluate adult HCV-seronegative LT recipients who received grafts from HCV-seropositive donors.From 01/18 to 09/19, 34 HCV-seronegative LT recipients received grafts from HCV-seropositive donors (20 HCV viremic and 14 non-viremic). Seven grafts were from cardiac-dead donors. Median allocated MELD-Na score was 20. Six underwent simultaneous liver-kidney transplant (SLK), 4 repeat LT. No recipient of an HCV non-viremic graft developed HCV viremia. All 20 patients who received HCV viremic grafts had HCV viremia confirmed within 3 days after LT. DAA treatment was started at the median time of 27.5 days. Median pre-treatment viral load was 723,000 IU/ml. All (20/20) patients completed treatment and achieved SVR 12. Treatment was well tolerated with minimal adverse events. One patient developed HCV related acute membranous nephropathy that resulted in end stage kidney disease, despite achieving viral clearance. This patient died due to presumed infectious complications. A recipient of an HCV non-viremic graft died with acute myocardial infarction 610 days post LT.LT using HCV-seropositive grafts to HCV-seronegative recipients resulted in excellent short-term outcomes, even with the use of DCD grafts and expansion into SLK or repeat LT. Anti-viral therapy was effective and well tolerated. Careful ongoing assessment regarding patient and graft selection as well as complications and prompt initiation of antiviral therapy is recommended. Longer term follow-up in carefully conducted clinical trials is still required to confirm those results.

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