Liver Transplantation of HCV-Viremic Donors into HCV-Negative Recipients in the USA: Increasing Frequency with Profound Geographic Variation.

BACKGROUND & AIMS Direct-acting antiviral (DAA) therapy made possible the novel practice of utilizing HCV-viremic (HCV-RNA-positive) donors into HCV-negative recipients in the United States. Although initial reports of outcomes have been satisfactory, higher-quality longer-term outcomes remain to be elucidated. METHODS National data was examined from the Organ Procurement and Transplantation Network (OPTN) on adult patients in the US who underwent a primary, single organ, deceased donor liver transplant from January 1, 2016, to March 31, 2020. Outcomes of HCV-negative recipients (R-) who received an allograft from donors who were HCV RNA-positive (D HCV+) were compared with HCV RNA-negative (D HCV-) donors. RESULTS There has been a 35-fold increase in D HCV+/R- liver transplants over the past 4 years in the US, from 8 in 2016 to 280 in 2019. There was an almost 6-fold difference in this practice among UNOS geographic regions. Graft survival following D HCV+/R- liver transplantation was excellent, with 1-year rates being 91% and 90% and 2-year rates being 88.5% and 87% for D HCV+/R- and D HCV-/R-, respectively (p=0.672). In multivariate analysis, adjusting for other donor and recipient attributes, D HCV+/R- was not predictive of patient or graft survival CONCLUSIONS:: The practice of D HCV+/R- continues to increase without discernible impact on medium-term outcomes. Notable geographic variation exists, suggesting inconsistent perceptions about the impact of D HCV+/R- transplantation on outcomes. These results strengthen the perceived safety in utilizing HCV viremic donor organs as a donor pool expansion strategy, not only in the USA, but also worldwide.