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Transplanting Hepatitis C-infected Livers Is Safe and Cost-effective

ANALYSIS of a large registry has shown hepatitis C (HCV)-positive livers to be safe for transplant, since the transplanted disease is controlled by direct-acting antiviral therapy. This data from researchers from the University of Chicago, Chicago, Illinois, USA may offer an increased pool of transplantable organs for patients in dire need of a transplant, as well as a considerable cost saving to healthcare systems.

The researchers analysed records from the Scientific Registry of Transplant Recipients from 2014–2018, comparing the trend of HCV-negative donors with HCV-negative recipients (n=11,270), negative donors with positive recipients (n=4,748), positive donors with negative recipients (n=87), and positive donors with positive recipients (n=753). Over this period, the number of HCV-positive donors had increased dramatically, with HCV-infected livers being transplanted into 269 HCV-positive patients and 46 HCV-negative patients in 2018, compared to 8 and 0 patients, respectively, in 2014. Graft survival times were not affected by donor status at 1 or 2 years; at 1 year, values ranged from 92.6% (negative-to-negative) to 94.3% (positive-to-positive) and were similarly comparable at 2 years (85.7–89.7% in positive-to-negative and positive-to-positive patients, respectively).

These results show that the recent advances in HCV management have made HCV-infected livers a viable option for patients with severe disease. “For someone who has a MELD (Model for End-Stage Liver Disease) score >20, who has a declining quality of life […] I think this is a great opportunity,” commented Dr Sonali Paul, University of Chicago.

The researchers note the practical caveats of their results, primarily that communicating the status of the donor liver to the patient is vital, as well as anticipating any insurance issues relating to the hepatitis C treatment. Nonetheless, these results represent a new, safe option for this vulnerable patient population, as well as the potential for significant cost-savings related to patients no longer waiting on transplant lists.