Skip to main content

Advertisement

SpringerLink
Log in

Use of Hepatitis C–Infected Deceased Donors in Liver Transplantation

  • Published:
Current Hepatitis Reports Aims and scope Submit manuscript

Abstract

The use of hepatitis C–infected (HCV+) liver donors for HCV+ transplant recipients was previously controversial, but mounting evidence now supports this practice. HCV-related cirrhosis accounts for 45% of the liver transplants in the United States; however, these transplant recipients have worse transplant outcomes when compared to non–HCV infected (HCV-) recipients. The optimal utility of the donor graft is therefore decreased with transplantation of HCV+ recipients because the largest percentage of organs are transplanted into patients with inferior survival outcomes. Increased use of HCV+ livers, which can only be transplanted into HCV+ recipients, provides additional transplant liver allografts directly targeted to the recipient population at greatest need. As HCV+ recipients are transplanted with previously unusable organs, more HCV- donor livers are available for the HCV- recipient population, thereby increasing the utility of HCV- grafts. Therefore, increased use of HCV+ donors results in increased utility of all available liver allografts and a shorter waitlist time to transplant, because the total number of available organs is increased. This review discusses the use of HCV+ donor livers in transplantation, including donor organ evaluation, hepatitis C in liver transplantation, a review of the available literature, and the future direction of HCV+ donors in transplantation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Tector AJ, Mangus RS, Chestovich P, et al.: Use of extended criteria livers decreases wait time for liver transplantation without adversely impacting posttransplant survival. Ann Surg 2006, 244:439–450.

    PubMed  Google Scholar 

  2. Renz JF, Yersiz H, Reichert PR, et al.: Split-liver transplantation: a review. Am J Transplant 2003, 3:1323–1335.

    Article  PubMed  Google Scholar 

  3. Renz JF, Kin C, Kinkhabwala M, et al.: Utilization of extended donor criteria liver allografts maximizes donor use and patient access to liver transplantation. Ann Surg 2005, 242:556–563; discussion 563–555.

    PubMed  Google Scholar 

  4. Ekser B, Gridelli B, Tector AJ, Cooper DK: Pig liver xenotransplantation as a bridge to allotransplantation: which patients might benefit? Transplantation 2009, 88:1041–1049.

    Article  PubMed  Google Scholar 

  5. McHutchison JG, Dev AT: Future trends in managing hepatitis C. Gastroenterol Clin North Am 2004, 33(1 Suppl):S51–S61.

    Article  PubMed  Google Scholar 

  6. Davis GL, Albright JE, Cook SF, Rosenberg DM: Projecting future complications of chronic hepatitis C in the United States. Liver Transpl 2003, 9:331–338.

    Article  PubMed  Google Scholar 

  7. McHutchison JG, Bacon BR: Hepatitis C: a 20-year debt comes due. Am J Manag Care 2004, 10(2 Suppl):S20.

    PubMed  Google Scholar 

  8. Firpi RJ, Abdelmalek MF, Soldevila-Pico C, et al.: One-year protocol liver biopsy can stratify fibrosis progression in liver transplant recipients with recurrent hepatitis C infection. Liver Transpl 2004, 10:1240–1247.

    Article  PubMed  Google Scholar 

  9. Saab S, Niho H, Comulada S, et al.: Mortality predictors in liver transplant recipients with recurrent hepatitis C cirrhosis. Liver Int 2005, 25:940–945.

    Article  PubMed  Google Scholar 

  10. Gallegos-Orozco JF, Yosephy A, Noble B, et al.: Natural history of post-liver transplantation hepatitis C: a review of factors that may influence its course. Liver Transpl 2009, 15:1872–1881.

    Article  PubMed  Google Scholar 

  11. Lucey MR, Schaubel DE, Guidinger MK, et al.: Effect of alcoholic liver disease and hepatitis C infection on waiting list and posttransplant mortality and transplant survival benefit. Hepatology 2009, 50:400–406.

    Article  PubMed  Google Scholar 

  12. McHutchison JG: Understanding hepatitis C. Am J Manag Care 2004, 10(2 Suppl):S21–S29.

    PubMed  Google Scholar 

  13. Natov SN, Pereira BJ: Transmission of viral hepatitis by kidney transplantation: donor evaluation and transplant policies (part 1: hepatitis B virus). Transpl Infect Dis 2002, 4:117–123.

    Article  PubMed  CAS  Google Scholar 

  14. Shah SA, Li YF, Singla A, Bozorgzadeh A: Liver transplantation using HCV positive donor allografts: a case controlled analysis of the UNOS database [abstract 51]. Presented at the Ninth American Transplant Congress. Boston, MA; May 30–June 3, 2009. Available at http://www.atcmeeting.org/2009/pdfs/ATC-09-Days.pdf. Accessed August 2010.

  15. Doria C, Rosen MM, Vaccino S, et al.: Hepatitis C+ liver grafts might be the most equitable solution for retransplantation in hepatitis C infected recipients: an analysis of 13+ years of OPTN data [abstract 51]. Presented at the Ninth American Transplant Congress. Boston, MA; May 30–June 3, 2009. Available at http://www.atcmeeting.org/2009/pdfs/ATC-09-Days.pdf. Accessed August 2010.

  16. Mangus RS, Wilson S, Kwo PY, et al.: Use of hepatitis C-infected donors in liver transplantation: a case-control study [abstract]. Transpl Int 2007, 20(S2):29. Abstract O102.

    Google Scholar 

  17. Fan X, Lang DM, Xu Y, et al.: Liver transplantation with hepatitis C virus-infected graft: interaction between donor and recipient viral strains. Hepatology 2003, 38:25–33.

    Article  PubMed  Google Scholar 

  18. Van Vlierberghe H, Troisi R, Colle I, et al.: Hepatitis C infection-related liver disease: patterns of recurrence and outcome in cadaveric and living-donor liver transplantation in adults. Transplantation 2004, 77:210–214.

    Article  PubMed  Google Scholar 

  19. Ghobrial RM, Saab S, Lassman C, et al.: Donor and recipient outcomes in right lobe adult living donor liver transplantation. Liver Transpl 2002, 8:901–909.

    Article  PubMed  Google Scholar 

  20. Arenas JI, Vargas HE, Rakela J: The use of hepatitis C-infected grafts in liver transplantation. Liver Transpl 2003, 9:S48–S51.

    Article  PubMed  Google Scholar 

  21. Feray C, Shouval D, Samuel D: Will transplantation of an hepatitis C-infected graft improve the outcome of liver transplantation in HCV patients? [comment]. Gastroenterology 1999, 117:263–265.

    Article  PubMed  CAS  Google Scholar 

  22. Ghobrial RM, Steadman R, Gornbein J, et al.: A 10-year experience of liver transplantation for hepatitis C: analysis of factors determining outcome in over 500 patients. Ann Surg 2001, 234:384–393; discussion 393–384.

    Article  PubMed  CAS  Google Scholar 

  23. Lake JR, Shorr JS, Steffen BJ, et al.: Differential effects of donor age in liver transplant recipients infected with hepatitis B, hepatitis C and without viral hepatitis. Am J Transplant 2005, 5:549–557.

    Article  PubMed  Google Scholar 

  24. Wali M, Harrison RF, Gow PJ, Mutimer D: Advancing donor liver age and rapid fibrosis progression following transplantation for hepatitis C. Gut 2002, 51:248–252.

    Article  PubMed  CAS  Google Scholar 

  25. Machicao VI, Bonatti H, Krishna M, et al.: Donor age affects fibrosis progression and graft survival after liver transplantation for hepatitis C. Transplantation 2004, 77:84–92.

    Article  PubMed  Google Scholar 

  26. Burak KW, Kremers WK, Batts KP, et al.: Impact of cytomegalovirus infection, year of transplantation, and donor age on outcomes after liver transplantation for hepatitis C. Liver Transpl 2002, 8:362–369.

    Article  PubMed  Google Scholar 

  27. Berenguer M, Prieto M, San Juan F, et al.: Contribution of donor age to the recent decrease in patient survival among HCV-infected liver transplant recipients. Hepatology 2002, 36:202–210.

    Article  PubMed  Google Scholar 

  28. Velidedeoglu E, Mange KC, Frank A, et al.: Factors differentially correlated with the outcome of liver transplantation in HCV+ and HCV- recipients. Transplantation 2004, 77:1834–1842.

    Article  PubMed  Google Scholar 

  29. Velidedeoglu E, Desai NM, Campos L, et al.: The outcome of liver grafts procured from hepatitis C-positive donors. Transplantation 2002, 73:582–587.

    Article  PubMed  Google Scholar 

  30. • Moonka DK, Kim D, Kapke A, et al.: The influence of induction therapy on graft and patient survival in patients with and without hepatitis C after liver transplantation. Am J Transplant 2010, 10:590–601. This recent article provides updated outcome information on a large volume of HCV + liver recipients.

    Article  PubMed  CAS  Google Scholar 

  31. Forman LM, Lewis JD, Berlin JA, et al.: The association between hepatitis C infection and survival after orthotopic liver transplantation. Gastroenterology 2002, 122:889–896.

    Article  PubMed  Google Scholar 

  32. Adam R, McMaster P, O’Grady JG, et al.: Evolution of liver transplantation in Europe: report of the European Liver Transplant Registry. Liver Transpl 2003, 9:1231–1243.

    Article  PubMed  Google Scholar 

  33. Mulligan DC, Goldstein RM, Crippin JS, et al.: Use of anti-hepatitis C virus seropositive organs in liver transplantation. Transplant Proc 1995, 27:1204–1205.

    PubMed  CAS  Google Scholar 

  34. Aswad S, Mendez R, Weingart RG, Mendez R: Expanding organ availability by using hepatitis C antibody positive donors. Transplant Proc 1993, 25:2270–2271.

    PubMed  CAS  Google Scholar 

  35. Aswad S, Obispo E, Mendez RG, Mendez R: HCV+ donors: should they be used for organ transplantation? Transplant Proc 1993, 25:3072–3074.

    PubMed  CAS  Google Scholar 

  36. Testa G, Goldstein RM, Netto G, et al.: Long-term outcome of patients transplanted with livers from hepatitis C-positive donors. Transplantation 1998, 65:925–929.

    Article  PubMed  CAS  Google Scholar 

  37. Torres M, Weppler D, Reddy KR, Tzakis A: Use of hepatitis C-infected donors for hepatitis C-positive OLT recipients [comment]. Gastroenterology 1999, 117:1253.

    Article  PubMed  CAS  Google Scholar 

  38. Vargas HE, Laskus T, Wang LF, et al.: Outcome of liver transplantation in hepatitis C virus-infected patients who received hepatitis C virus-infected grafts. Gastroenterology 1999, 117:149–153.

    Article  PubMed  CAS  Google Scholar 

  39. Marroquin CE, Marino G, Kuo PC, et al.: Transplantation of hepatitis C-positive livers in hepatitis C-positive patients is equivalent to transplanting hepatitis C-negative livers. Liver Transpl 2001, 7:762–768.

    Article  PubMed  CAS  Google Scholar 

  40. Saab S, Ghobrial RM, Ibrahim AB, et al.: Hepatitis C positive grafts may be used in orthotopic liver transplantation: a matched analysis. Am J Transplant 2003, 3:1167–1172.

    Article  PubMed  Google Scholar 

  41. Saab S, Chang AJ, Comulada S, et al.: Outcomes of hepatitis C- and hepatitis B core antibody-positive grafts in orthotopic liver transplantation. Liver Transpl 2003, 9:1053–1061.

    Article  PubMed  Google Scholar 

  42. Khapra AP, Agarwal K, Fiel MI, et al.: Impact of donor age on survival and fibrosis progression in patients with hepatitis C undergoing liver transplantation using HCV+ allografts. Liver Transpl 2006, 12:1496–1503.

    Article  PubMed  Google Scholar 

  43. Prati D, Capelli C, Zanella A, et al.: Influence of different hepatitis C virus genotypes on the course of asymptomatic hepatitis C virus infection. Gastroenterology 1996, 110:178–183.

    Article  PubMed  CAS  Google Scholar 

  44. Radkowski M, Wang LF, Vargas H, et al.: Changes in hepatitis C virus population in serum and peripheral blood mononuclear cells in chronically infected patients receiving liver graft from infected donors. Transplantation 2001, 72:833–838.

    Article  PubMed  CAS  Google Scholar 

  45. Laskus T, Wang LF, Rakela J, et al.: Dynamic behavior of hepatitis C virus in chronically infected patients receiving liver graft from infected donors. Virology 1996, 220:171–176.

    Article  PubMed  CAS  Google Scholar 

  46. Bahra M, Jacob D, Neumann UP, et al.: Influence of donor histology on outcome in patients undergoing transplantation for hepatitis C. Transplantation 2007, 84:144–148.

    Article  PubMed  Google Scholar 

  47. Based on Organ Procurement and Transplantation Network data as of January 1, 2008. This work was supported in part by Health Resources and Services Administration contract 234-2005-370011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.

  48. Brown KL, El-Amm JM, Doshi MD, et al.: Intermediate-term outcomes of hepatitis C-positive compared with hepatitis C-negative deceased-donor renal allograft recipients. Am J Surg 2008, 195:298–302; discussion 302–293.

    Article  PubMed  Google Scholar 

Download references

Disclosure

No potential conflict of interest relevant to this article was reported.

Author information

Authors and Affiliations

  1. Transplantation Section, Department of Surgery, Transplant Section, Indiana University School of Medicine, 550 North University Boulevard, Room 4601, Indianapolis, IN, 46202-5250, USA

    Richard S. Mangus

Authors
  1. Richard S. Mangus
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Richard S. Mangus.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mangus, R.S. Use of Hepatitis C–Infected Deceased Donors in Liver Transplantation. Curr Hepatitis Rep 9, 253–259 (2010). https://doi.org/10.1007/s11901-010-0057-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11901-010-0057-z

Keywords

Search

Navigation