Current Hepatology Reports

, Volume 16, Issue 1, pp 12–17 | Cite as

Use of Hepatitis C-Positive Donor Livers in Liver Transplantation

  • Daniel Bushyhead
  • David GoldbergEmail author
Hepatitis C (J Ahn and A Aronsohn, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Hepatitis C


Purpose of Review

The purpose of this article is to review recent literature regarding the use of hepatitis C virus (HCV)-positive donor livers in liver transplantation. Given the prevalence of HCV-positive patients on the waitlist coupled with high waitlist mortality, use of HCV-positive livers may be a means to meet patient needs. This review seeks to primarily answer the following questions: can HCV-positive livers be used safely and effectively? Are new direct-acting antiviral medications safe and effective in HCV-positive liver recipients?

Recent Findings

Use of HCV-positive donor livers for liver transplantation in HCV-positive recipients is increasing. These donor livers have equivalent patient and graft survival when compared to HCV-negative donor livers in HCV-positive liver transplant recipients. Recent studies suggest that use of direct-acting antiviral medications in HCV-positive liver transplant recipients can be successful, although there is insufficient data for their use in recipients of HCV-positive donor livers.


HCV-positive donor livers may be safely and effectively used in HCV-positive liver transplant recipients. Direct-acting antiviral medications appear safe and effective in HCV-positive liver transplant recipients, but data on their efficacy in HCV-positive donor liver transplant recipients are limited. Future research should focus on the use of HCV-positive donor livers in HCV-negative liver transplant recipients.


Hepatitis C virus Liver transplantation Direct-acting antivirals HCV-positive organs HCV-positive livers HCV-positive liver transplantation 


Compliance with Ethical Standards

Conflict of Interest

Daniel Bushyhead and David Goldberg each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).


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

  1. 1.
    Viral hepatitis—statistics & surveillance. Center for Disease Control and Prevention. 2016. Accessed 11 Nov 2016.
  2. 2.
    Organ Procurement and Transplantation Network—2014 data report. 2016. Accessed 3 June 2016.
  3. 3.
    Hashimoto K, Miller C. The use of marginal grafts in liver transplantation. J Hepatobiliary Pancreat Surg. 2008;15:92. doi: 10.1007/s00534-007-1300-z.CrossRefPubMedGoogle Scholar
  4. 4.
    Bowring MG, Kucirka LM, Massie AB, Luo X, Cameron A, Sulkowski M, et al. Changes in utilization and discard of hepatitis C-infected donor livers in the recent era. Am J Transplant. 2016. doi: 10.1111/ajt.13976.Google Scholar
  5. 5.
    • Northup PG, Argo CK, Nguyen DT, McBride MA, Kumer SC, Schmitt TM, et al. Liver allografts from hepatitis C positive donors can offer good outcomes in hepatitis C positive recipients: a US National Transplant Registry analysis. Transpl Int. 2010;23:1038–44. doi: 10.1111/j.1432-2277.2010.01092.x. This is the largest study to analyze outcomes for HCV-positive donor livers in HCV-positive liver transplant recipients. CrossRefPubMedGoogle Scholar
  6. 6.
    Marroquin CE, Marino G, Kuo PC, Plotkin JS, Rustgi VK, Lu AD, et al. Transplantation of hepatitis C-positive livers in hepatitis C-positive patients is equivalent to transplanting hepatitis C-negative livers. Liver Transpl. 2001;7:762–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Álvaro E, Abradelo M, Fuertes A, Manrique A, Colina F, Alegre C, et al. Liver transplantation from anti-hepatitis C virus-positive donors: our experience. Transplant Proc. 2012;44:1475–8. doi: 10.1016/j.transproceed.2012.05.012.CrossRefPubMedGoogle Scholar
  8. 8.
    Ballarin R, Cucchetti A, Spaggiari M, Montalti R, Di Benedetto F, Nadalin S, et al. Long-term follow-up and outcome of liver transplantation from anti-hepatitis C virus-positive donors: a European multicentric case-control study. Transplantation. 2011;91:1265–72. doi: 10.1097/TP.0b013e318219eb8f.CrossRefPubMedGoogle Scholar
  9. 9.
    O’Leary JG, Neri MA, Trotter JF, Davis GL, Klintmalm GB. Utilization of hepatitis C antibody-positive livers: genotype dominance is virally determined. Transpl Int. 2012;25:825–9. doi: 10.1111/j.1432-2277.2012.01498.x.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Tugwell BD, Patel PR, Williams IT, Hedberg K, Chai F, Nainan O, et al. Transmission of hepatitis C virus to several organ and tissue recipients from an antibody-negative donor. Ann Intern Med. 2005;143:648–54.CrossRefPubMedGoogle Scholar
  11. 11.
    Lai JC, O’Leary JG, Trotter JF, Verna EC, Brown RS, Stravitz RT, et al. Risk of advanced fibrosis with grafts from hepatitis C antibody-positive donors: a multicenter cohort study. Liver Transpl. 2012;18:532–8. doi: 10.1002/lt.23396.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Gane EJ. Diabetes mellitus following liver transplantation in patients with hepatitis C virus: risks and consequences. Am J Transplant. 2012;12:531–8. doi: 10.1111/j.1600-6143.2011.03854.x.CrossRefPubMedGoogle Scholar
  13. 13.
    Thuluvath PJ, Guidinger MK, Fung JJ, Johnson LB, Rayhill SC, Pelletier SJ. Liver transplantation in the United States, 1999–2008. Am J Transplant. 2010;10:1003–19. doi: 10.1111/j.1600-6143.2010.03037.x.CrossRefPubMedGoogle Scholar
  14. 14.
    Coilly A, Roche B, Samuel D. Current management and perspectives for HCV recurrence after liver transplantation. Liver Int. 2013;33:56–62. doi: 10.1111/liv.12062.CrossRefPubMedGoogle Scholar
  15. 15.
    Berenguer M, Schuppan D. Progression of liver fibrosis in post-transplant hepatitis C: mechanisms, assessment and treatment. J Hepatol. 2013;58:1028–41. doi: 10.1016/j.jhep.2012.12.014.CrossRefPubMedGoogle Scholar
  16. 16.
    Berenguer M. Systematic review of the treatment of established recurrent hepatitis C with pegylated interferon in combination with ribavirin. J Hepatol. 2008;49:274–87. doi: 10.1016/j.jhep.2008.05.002.CrossRefPubMedGoogle Scholar
  17. 17.
    Charlton M, Gane E, Manns MP, Brown RS, Curry MP, Kwo PY, et al. Sofosbuvir and ribavirin for treatment of compensated recurrent hepatitis C virus infection after liver transplantation. Gastroenterology. 2015;148:108–17. doi: 10.1053/j.gastro.2014.10.001.CrossRefPubMedGoogle Scholar
  18. 18.
    Kwo PY, Mantry PS, Coakley E, Te HS, Vargas HE, Brown R, et al. An interferon-free antiviral regimen for HCV after liver transplantation. N Engl J Med. 2014;371:2375–82. doi: 10.1056/NEJMoa1408921.CrossRefPubMedGoogle Scholar
  19. 19.
    Pungpapong S, Aqel B, Leise M, Werner KT, Murphy JL, Henry TM, et al. Multicenter experience using simeprevir and sofosbuvir with or without ribavirin to treat hepatitis C genotype 1 after liver transplant. Hepatology. 2015;61:1880–6. doi: 10.1002/hep.27770.CrossRefPubMedGoogle Scholar
  20. 20.
    • Forns X, Charlton M, Denning J, McHutchison JG, Symonds WT, Brainard D, et al. Sofosbuvir compassionate use program for patients with severe recurrent hepatitis C after liver transplantation. Hepatology. 2015;61:1485–94. doi: 10.1002/hep.27681. This article examined the safety and efficacy of direct acting antiviral medications in patients with severe liver disease. CrossRefPubMedGoogle Scholar
  21. 21.
    Dumortier J, Leroy V, Duvoux C, de Ledinghen V, Francoz C, Houssel-Debry P, et al. Sofosbuvir-based treatment of hepatitis C with severe fibrosis (METAVIR F3/F4) after liver transplantation. Liver Transpl. 2016;22:1367–78. doi: 10.1002/lt.24505.CrossRefPubMedGoogle Scholar
  22. 22.
    Charlton M, Everson GT, Flamm SL, Kumar P, Landis C, Brown RS, et al. Ledipasvir and sofosbuvir plus ribavirin for treatment of HCV infection in patients with advanced liver disease. Gastroenterology. 2015;149:649–59. doi: 10.1053/j.gastro.2015.05.010.CrossRefPubMedGoogle Scholar
  23. 23.
    Leroy V, Dumortier J, Coilly A, Sebagh M, Fougerou-Leurent C, Radenne S, et al. Efficacy of sofosbuvir and daclatasvir in patients with fibrosing cholestatic hepatitis C after liver transplantation. Clin Gastroenterol Hepatol. 2015;13:1993–2001.e1-2. doi: 10.1016/j.cgh.2015.05.030.
  24. 24.
    Gutierrez JA, Carrion AF, Avalos D, O’Brien C, Martin P, Bhamidimarri KR, et al. Sofosbuvir and simeprevir for treatment of hepatitis C virus infection in liver transplant recipients. Liver Transpl. 2015;21:823–30. doi: 10.1002/lt.24126.CrossRefPubMedGoogle Scholar
  25. 25.
    Coilly A, Fougerou-Leurent C, de Ledinghen V, Houssel-Debry P, Duvoux C, Di Martino V, et al. Multicentre experience using daclatasvir and sofosbuvir to treat hepatitis C recurrence—the ANRS CUPILT study. J Hepatol. 2016;65:711–8. doi: 10.1016/j.jhep.2016.05.039.CrossRefPubMedGoogle Scholar
  26. 26.
    Araiz JJ, Serrano MT, García-Gil FA, Lacruz EM, Lorente S, Sánchez JI, et al. Intention-to-treat survival analysis of hepatitis C virus/human immunodeficiency virus coinfected liver transplant: is it the waiting list? Liver Transpl. 2016;22:1186–96. doi: 10.1002/lt.24474.CrossRefPubMedGoogle Scholar
  27. 27.
    Stock PG, Terrault NA. Human immunodeficiency virus and liver transplantation: hepatitis C is the last hurdle. Hepatology. 2015;61:1747–54. doi: 10.1002/hep.27553.CrossRefPubMedGoogle Scholar
  28. 28.
    Terrault NA, Roland ME, Schiano T, Dove L, Wong MT, Poordad F, et al. Outcomes of liver transplant recipients with hepatitis C and human immunodeficiency virus coinfection. Liver Transpl. 2012;18:716–26. doi: 10.1002/lt.23411.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Reese PP, Abt PL, Blumberg EA, Goldberg DS. Transplanting hepatitis C-positive kidneys. N Engl J Med. 2015;373:303–5. doi: 10.1056/NEJMp1505074.CrossRefPubMedGoogle Scholar
  30. 30.
    Zepatier for treatment of hepatitis C-negative patients who receive kidney transplants from hepatitis C-positive donors (HCV). 2016. Accessed 20 November 2016.Google Scholar
  31. 31.
    Goldberg DS, Blumberg E, McCauley M, Abt P, Levine M. Improving organ utilization to help overcome the tragedies of the opioid epidemic. Am J Transplant. 2016. doi: 10.1111/ajt.13971.Google Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of Medicine, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Division of Gastroenterology, Department of Medicine, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA

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