Treatment of Hepatitis C Post-Liver Transplantation Could Mitigate Discard Rates of Hepatitis C-Positive Deceased Donor Livers and Expand the Donor Pool
Background. Prior to 2014, treatment for hepatitis C was limited. However, the subsequent introduction of direct acting antiviral medications (DAA) against hepatitis C led to improvements in morbidity and better medication tolerance. DAA therapy allowed for an increase in treatment rates of hepatiti...
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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| Series: | Journal of Transplantation |
| Online Access: | http://dx.doi.org/10.1155/2021/6612453 |
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| author | Jennifer Keller Gary Marklin Obi Okoye Roshani Desai Tej Sura Ajay Jain Chintalapati Varma Mustafa Nazzal |
| author_facet | Jennifer Keller Gary Marklin Obi Okoye Roshani Desai Tej Sura Ajay Jain Chintalapati Varma Mustafa Nazzal |
| author_sort | Jennifer Keller |
| collection | DOAJ |
| description | Background. Prior to 2014, treatment for hepatitis C was limited. However, the subsequent introduction of direct acting antiviral medications (DAA) against hepatitis C led to improvements in morbidity and better medication tolerance. DAA therapy allowed for an increase in treatment rates of hepatitis C in patients on the liver transplant waiting list. With the popularization of DAA, there became a growing concern about the utility of hepatitis C-positive (HCV+) deceased liver donors, especially after treating HCV+ potential recipients on the transplant waiting list. Methods. This is a retrospective, observational study using Mid-America Transplant Services (MTS) database from 2008 to 2017. Comparison was made before the widespread use of DAAs 2008–2013 (pre-DAA) against their common practice use 2014–2017 (post-DAA). All deceased liver donors with HCV antibody or nucleic acid positive results were evaluated. Results. Between 2008 and 2017, 96 deceased liver donors were positive for HCV. In the pre-DAA era, 47 deceased liver donors were positive for HCV, of which 32 (68.1%) were transplanted and 15 (31.9%) were discarded. In the post-DAA era, a total of 49 HCV+ organs were identified, out of which 43 (87.8%) livers were transplanted and 6 (12.2%) were discarded. Discard rate was significantly higher in the pre-DAA population (31.9% vs. 12.2%, p = 0.026). Secondary analysis showed a distinct trend towards increased regional sharing and utilization of HCV+ donors. Conclusion. In order to reduce discard rates of HCV+ patients, our data suggest that transplant centers could potentially delay HCV treatment in patients on the transplant waitlist. |
| format | Article |
| id | doaj-art-8557e8cc22aa4bd4b05ba59289adb031 |
| institution | Kabale University |
| issn | 2090-0007 2090-0015 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Transplantation |
| spelling | doaj-art-8557e8cc22aa4bd4b05ba59289adb0312025-02-03T01:24:39ZengWileyJournal of Transplantation2090-00072090-00152021-01-01202110.1155/2021/66124536612453Treatment of Hepatitis C Post-Liver Transplantation Could Mitigate Discard Rates of Hepatitis C-Positive Deceased Donor Livers and Expand the Donor PoolJennifer Keller0Gary Marklin1Obi Okoye2Roshani Desai3Tej Sura4Ajay Jain5Chintalapati Varma6Mustafa Nazzal7Division of Abdominal Transplant, Saint Louis University, St. Louis, MO, USAMid-America Transplant Services, St. Louis, MO, USADivision of Abdominal Transplant, Saint Louis University, St. Louis, MO, USADivision of Hepatology, Saint Louis University, St. Louis, MO, USASaint Louis University School of Medicine, St. Louis, MO, USASaint Louis University School of Medicine, St. Louis, MO, USADivision of Abdominal Transplant, Saint Louis University, St. Louis, MO, USADivision of Abdominal Transplant, Saint Louis University, St. Louis, MO, USABackground. Prior to 2014, treatment for hepatitis C was limited. However, the subsequent introduction of direct acting antiviral medications (DAA) against hepatitis C led to improvements in morbidity and better medication tolerance. DAA therapy allowed for an increase in treatment rates of hepatitis C in patients on the liver transplant waiting list. With the popularization of DAA, there became a growing concern about the utility of hepatitis C-positive (HCV+) deceased liver donors, especially after treating HCV+ potential recipients on the transplant waiting list. Methods. This is a retrospective, observational study using Mid-America Transplant Services (MTS) database from 2008 to 2017. Comparison was made before the widespread use of DAAs 2008–2013 (pre-DAA) against their common practice use 2014–2017 (post-DAA). All deceased liver donors with HCV antibody or nucleic acid positive results were evaluated. Results. Between 2008 and 2017, 96 deceased liver donors were positive for HCV. In the pre-DAA era, 47 deceased liver donors were positive for HCV, of which 32 (68.1%) were transplanted and 15 (31.9%) were discarded. In the post-DAA era, a total of 49 HCV+ organs were identified, out of which 43 (87.8%) livers were transplanted and 6 (12.2%) were discarded. Discard rate was significantly higher in the pre-DAA population (31.9% vs. 12.2%, p = 0.026). Secondary analysis showed a distinct trend towards increased regional sharing and utilization of HCV+ donors. Conclusion. In order to reduce discard rates of HCV+ patients, our data suggest that transplant centers could potentially delay HCV treatment in patients on the transplant waitlist.http://dx.doi.org/10.1155/2021/6612453 |
| spellingShingle | Jennifer Keller Gary Marklin Obi Okoye Roshani Desai Tej Sura Ajay Jain Chintalapati Varma Mustafa Nazzal Treatment of Hepatitis C Post-Liver Transplantation Could Mitigate Discard Rates of Hepatitis C-Positive Deceased Donor Livers and Expand the Donor Pool Journal of Transplantation |
| title | Treatment of Hepatitis C Post-Liver Transplantation Could Mitigate Discard Rates of Hepatitis C-Positive Deceased Donor Livers and Expand the Donor Pool |
| title_full | Treatment of Hepatitis C Post-Liver Transplantation Could Mitigate Discard Rates of Hepatitis C-Positive Deceased Donor Livers and Expand the Donor Pool |
| title_fullStr | Treatment of Hepatitis C Post-Liver Transplantation Could Mitigate Discard Rates of Hepatitis C-Positive Deceased Donor Livers and Expand the Donor Pool |
| title_full_unstemmed | Treatment of Hepatitis C Post-Liver Transplantation Could Mitigate Discard Rates of Hepatitis C-Positive Deceased Donor Livers and Expand the Donor Pool |
| title_short | Treatment of Hepatitis C Post-Liver Transplantation Could Mitigate Discard Rates of Hepatitis C-Positive Deceased Donor Livers and Expand the Donor Pool |
| title_sort | treatment of hepatitis c post liver transplantation could mitigate discard rates of hepatitis c positive deceased donor livers and expand the donor pool |
| url | http://dx.doi.org/10.1155/2021/6612453 |
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