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Despite the increasing push for using HCV-positive organs to expand the donor pool, hundreds of livers allografts from donors are still not being used in transplantation.
Liver donors who are positive for Hepatitis C Virus (HCV) are generally healthier and have superior liver allografts in comparison with HCV-negative donors, according to a new study.
In light of the persistent problem of national organ shortages, it has become imperative to look for means to address this issue and ultimately expand the donor pool. As such, using HCV-positive organs have largely been endorsed as a potential solution to combat this organ shortage.
And yet, despite the increasing awareness as well as advancements in HCV treatment, many HCV-positive liver allografts—as many as several hundreds per year—still fail to be used in transplantation.
In this cross-sectional study, Ben Da, MD, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, and colleagues used the Scientific Registry of Transplant Recipients (SRTR) database to compare HCV-positive donor characteristics with HCV-negative donors.
Additionally, they evaluated regional variations in the utilization of HCV-positive liver allografts in the United States.
“In doing so, we intended to identify the challenges contributing to the underutilization of HCV-positive liver allografts,” the team wrote. “We believe these data are essential to drive the increased use of HCV-positive donors moving forward.”
The Study: Assessing HCV-Positive Versus Negative Donors
Thus, of the 24,500 donors utilized for liver transplantation between June 1, 2015 – December 1, 2018, 1887 (7.7%) of them were HCV antibody positive. Furthermore, 64.4% of HCV-positive donors were HCV nucleic acid test (NAT) positive.
The investigators noted that the HCV antibody positive donors trended towards being younger (median age, 35 years) in comparison with the HCV-negative donors (median age, 40 years).
Additionally, HCV positive donors had fewer comorbidities. For example, in the positive cohort, 8.3% had diabetes—versus 12.0% in the negative cohort (P<.001). Similarly, 25.9% of HCV-positive donors had hypertension, as did 35.2% of HCV-negative donors (P<.001).
As many as 67.7% of HCV antibody positive donors underwent liver biopsy, whereas 36.2% of negative donors underwent biopsy. On biopsy, the positive donor allografts were less likely to have microvesicular (52.9% versus 58.3%, for negative; P = .001) and macrovesicular steatosis (53.0$ versus 63.1%; P<.001).
Da and colleagues also noted that HCV antibody positive allografts had a lower median liver donor risk index (1.2) when compared with antibody negative donors (1.4; P<.001).
And finally, the investigators reported on geographic variation in utilization according to Organ Procurement and Transplantation Network regions.
Certain regions, like the New England region and Midwest and South East, had the highest absolute utilization of HCV antibody positive donors, which accounted for 64.4% of all HCV antibody positive donors used in the United States.
Region 1, or the New England region, was noted as having the highest utilization of HCV positive donors (18.7%) relative to the other regions.
“The use of HCV Ab–positive donors in some regions was associated with the rate of drug overdose, but this was not always the case,” the investigators wrote.
Thus, they believed that the geography of the opioid epidemic may not entirely explain these substantial regional variations in HCV positive organ utilization.
Perspective and Conclusion
“As physicians, we must be diligent in guiding our patients by highlighting the risks and benefits that come with accepting an HCV-positive donor and providing adequate informed consent,” the team concluded.
They suggested that using social media as a way to disseminate knowledge about the use of HCV-positive donors to physicians and patients across the country may help in this effort to remove the social stigma attached to the use of HCV-positive grafts as well as improve overall perceptions.
The study, “Donor Characteristics and Regional Differences in the Utilization of HCV-Positive Donors in Liver Transplantation,” was published online in JAMA Network Open.