*Purpose: 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.

*Methods: This is a retrospective analysis of prospectively collected database of an ongoing multicenter IRB-approved research study expanded into clinical protocol to evaluate adult HCV-seronegative LT recipients who received grafts from HCV-seropositive donors.

*Results: Since January 2018, 10 HCV-seronegative LT recipients received grafts from HCV-seropositive brain-dead donors [3 with negative nucleic acid testing (NAT) and 7 with positive NAT] with the median allocated MELD-Na score of 20. Two underwent simultaneous liver-kidney transplant (SLK), 2 repeat LT and 1 with SLT/repeat LT. The median waiting times were 266 days (range: 0-988) prior to listing for HCV-seropositive donor and 57 days (range: 9-238) to LT after listing for HCV-seropositive donor. No recipient of an HCV-NAT negative graft developed HCV viremia with median post LT follow-up of 48 days. All 7 patients who received HCV-NAT positive grafts had HCV viremia confirmed within 5 days after LT with the median peak HCV RNA of 33.1 million IU/mL (range 1-97.5 million). DAA treatment was started at the median time of 32 days (range 6-62) after LT: glecaprevir/pibrentasvir (G/P) for 12 weeks (5 patients), ledipasvir/sofosbuvir (LDV/SOF) + ribavirin (RBV) for 12 weeks (1 patient), and 1 patient is waiting for insurance approval. All were HCV RNA undetectable by week 4. Mild AST/ALT elevation was observed, but not associated with graft dysfunction. Acute cellular rejection was biopsy diagnosed in 3 patients, acute membranous nephropathy due to HCV infection in one patient. All were NAT positive primary LT patients. No graft loss or death was observed.

*Conclusions: LT using HCV-seropositive grafts to HCV-seronegative recipients resulted in acceptable short-term outcomes in our multicenter experience. This preliminary data supports continued use of HCV-seropositive grafts with expansion to SLK or repeat LT. Careful ongoing assessment regarding complications and timing of treatment is required.

« Back to 2019 American Transplant Congress