Chronic hepatitis C virus infection (HCV) is the leading indication for liver transplantation (LT) in the US. Safe and effective directly acting antivirals (DAAs) are now available to cure HCV. However, little is known about center attitudes and practices for incorporating DAAs into existing transplant protocols. The optimal timing of HCV treatment may depend on patient factors such as severity of liver disease, regional use of HCV+ donors, and indication for LT. We describe transplant center attitudes and practices for treating HCV in the context of liver transplantation.

Methods: We surveyed LT programs in the US based on center volume (top 50%). We asked centers to identify one individual best qualified to represent the attitudes and practices of their center to complete the survey. Questions focused on the use of HCV+ donors, treatment practices for HCV+ patients pre- and post-transplant before and after the advent of DAA therapy, and retransplantion.

Results: Of the centers contacted, 26% completed the survey. All centers reported using HCV+ liver donors for HCV+ recipients, and 53% restricted HCV+ donors based on donor age. Of those, since DAAs became available 75% have expanded their criteria and now use older HCV+ donors. Only 53% reported having standard protocols for treating HCV+ patients on the LT waitlist, and 80% identified third party payers as a current barrier to treating HCV+ patients pre- or post-LT. Additional treatment changes are summarized in Table 1.

Conclusion: Since the advent of DAAs, centers are more willing to treat HCV+ patients, both LT candidates and recipients. Centers are also broadening their consideration for how to use HCV+ liver donors.

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