Expanding the liver donor pool worldwide with hepatitis C infected livers, is it the time?

Abstract

Liver transplantation (LT) provides a life-saving option for cirrhotic patients with complications and hepatocellular carcinoma. Despite the increasing number of liver transplants performed each year, the number of LT candidates on the waitlist remains unchanged due to an imbalance between donor organ supply and the demand which increases the waitlist time and mortality. Living donor liver transplant had a great role in increasing the donor pool and shortened waitlist time for LT candidates. Nevertheless, further strategies can be implemented to increase the pool of potential donors in deceased donor LT, such as reducing the rate of organ discards. Utilizing hepatitis C virus (HCV) seropositive liver grafts is one of the expanded donor organ criteria. A yearly increase of hundreds of transplants is anticipated as a result of maximizing the utilization of HCV-positive organs for HCV-negative recipients. Direct-acting antiviral therapy's efficacy has revolutionized the treatment of HCV infection and the use of HCV-seropositive donors in transplantation. The American Society of Transplantation advises against performing transplants from HCV-infected liver donors (D+) into HCV-negative recipient (R-) unless under Institutional Review Board-approved study rules and with full informed consent of the knowledge gaps associated with such transplants. Proper selection of patients to be transplanted with HCV-infected grafts and confirming their access to direct-acting antivirals if needed is important. National and international consensuses are needed to regulate this process to ensure the maximum benefit and the least adverse events.

Keywords: Donor pool; Hepatitis C-viremic organs; Non-viremic organs; Direct acting antivirals; Hepatitis C virus treated; Liver transplantation.

Core Tip: There is an imbalance between donor organ supply in liver transplantation and the demand. Unfulfilled demands in organ transplant communities prompt new approaches to increasing donor pools. Direct acting antiviral (DAA) regimens have proved higher efficacy in treating hepatitis C virus (HCV). Available data shows that HCV non-viremic donor organs can be used in HCV-negative or positive liver transplant candidates safely. Furthermore, using liver grafts from HCV-viremic donors in liver transplant candidates, even if they were HCV negative, is showing favorable outcomes. Preoperative informed consent and easy access to DAAs with the engagement of clinical pharmacists are indispensable to ensuring these good outcomes.