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Hepatitis C-Positive Organs for Liver and Kidney Transplantation—Emerging Data and Current Management Strategies

  • Hepatitis C (H Vargas and S Flamm, Section Editors)
  • Published:
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Abstract

Purpose of Review

We aim to review the current guidelines and emerging data and compare the pros and cons for the use of HCV-positive organs.

Recent Findings

Some recent data suggests that the use of HCV-positive livers and kidneys safely increases the organ pool, additionally reducing wait list time, healthcare costs, and mortality.

Summary

Despite this therapeutic breakthrough, the demand for organs and waitlist mortality remains high. Every year, thousands of viable hepatitis C-positive organs are discarded. The emerging data regarding transplantation of HCV-positive organs is promising; however, further research is warranted with larger samples. A literature search was conducted using PubMed, using the keywords “transplant recipients,” “hepatitis C,” “kidney transplantation,” “liver transplantation,” “direct acting antivirals,” and “pre transplant.” Only articles in the English language were included.

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References

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

  1. Schnitzler MA, Lentine KL, Burroughs TE. The cost effectiveness of deceased organ donation. Transplantation. 2005;80(11):1636–7.

    Article  PubMed  Google Scholar 

  2. Schnitzler MA, Whiting JF, Brennan DC, Lentine KL, Desai NM, Chapman W, et al. The life-years saved by a deceased organ donor. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2005;5(9):2289–96. https://doi.org/10.1111/j.1600-6143.2005.01021.x.

    Article  Google Scholar 

  3. Kucirka LM, Singer AL, Ros RL, Montgomery RA, Dagher NN, Segev DL. Underutilization of hepatitis C-positive kidneys for hepatitis C-positive recipients. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2010;10(5):1238–46. https://doi.org/10.1111/j.1600-6143.2010.03091.x.

    Article  CAS  Google Scholar 

  4. Habka D, Mann D, Landes R, Soto-Gutierrez A. Future economics of liver transplantation: a 20-year cost modeling forecast and the prospect of bioengineering autologous liver grafts. PLoS One. 2015;10(7):e0131764. https://doi.org/10.1371/journal.pone.0131764.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Gonzalez SA, Trotter JF. The rise of the opioid epidemic and hepatitis C-positive organs: a new era in liver transplantation. Hepatology. 2018;67(4):1600–8. https://doi.org/10.1002/hep.29572.

    Article  PubMed  Google Scholar 

  6. Durand CM, Bowring MG, Thomas AG, Kucirka LM, Massie AB, Cameron A, et al. The drug overdose epidemic and deceased-donor transplantation in the United States: a national registry study. Ann Intern Med. 2018;168(10):702–11. https://doi.org/10.7326/m17-2451.

    Article  PubMed  PubMed Central  Google Scholar 

  7. • Axelrod DA, Schnitzler MA, Alhamad T, Gordon F, Bloom RD, Hess GP, et al. The impact of direct-acting antiviral agents on liver and kidney transplant costs and outcomes. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2018;18(10):2473–82. https://doi.org/10.1111/ajt.14895 Important initial study, demonstrating that DAA therapy improves HCV-positive transplant outcomes.

    Article  CAS  Google Scholar 

  8. Mucke MM, Mucke VT, Lange CM, Zeuzem S. Managing hepatitis C in patients with the complications of cirrhosis. Liver int. 2018;38(Suppl 1):14–20. https://doi.org/10.1111/liv.13636.

  9. Curry MP, O’Leary JG, Bzowej N, Muir AJ, Korenblat KM, Fenkel JM, et al. Sofosbuvir and Velpatasvir for HCV in patients with decompensated cirrhosis. N Engl J Med. 2015;373(27):2618–28. https://doi.org/10.1056/NEJMoa1512614.

    Article  CAS  PubMed  Google Scholar 

  10. Chascsa DM, Mousa OY, Pungpapong S, Zhang N, Chervenak A, Nidamanuri S, et al. Clinical outcomes of hepatitis C treatment before and after kidney transplantation and its impact on time to transplant: a multicenter study. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2018;18(10):2559–65. https://doi.org/10.1111/ajt.14931.

    Article  CAS  Google Scholar 

  11. Trotter PB, Summers DM, Ushiro-Lumb I, Robb M, Bradley JA, Powell J, et al. Use of organs from hepatitis C virus-positive donors for uninfected recipients: a potential cost-effective approach to save lives? Transplantation. 2018;102(4):664–72. https://doi.org/10.1097/tp.0000000000002033.

    Article  PubMed  Google Scholar 

  12. Levitsky J, Formica RN, Bloom RD, Charlton M, Curry M, Friedewald J, et al. The American Society of Transplantation Consensus Conference on the use of hepatitis C viremic donors in solid organ transplantation. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2017;17(11):2790–802. https://doi.org/10.1111/ajt.14381.

    Article  CAS  Google Scholar 

  13. Albertoni G, Castelo Girao MJ, Schor N. Mini review: current molecular methods for the detection and quantification of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus type 1. Int J Infect Dis. 2014;25:145–9. https://doi.org/10.1016/j.ijid.2014.04.007.

    Article  CAS  PubMed  Google Scholar 

  14. Kaberg M, Naver G, Hammarberg A, Weiland O. Incidence and spontaneous clearance of hepatitis C virus (HCV) in people who inject drugs at the Stockholm Needle Exchange-importance for HCV elimination. J Viral Hepat. 2018;25(12):1452–61. https://doi.org/10.1111/jvh.12969.

    Article  CAS  PubMed  Google Scholar 

  15. 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 Off J Am Soc Transplant Am Soc Transplant Surg. 2017;17(2):519–27. https://doi.org/10.1111/ajt.13976.

    Article  CAS  Google Scholar 

  16. Lai JC, O’Leary JG, Trotter JF, Verna EC, Brown RS Jr, Stravitz RT, et al. Risk of advanced fibrosis with grafts from hepatitis C antibody-positive donors: a multicenter cohort study. Liver Transpl. 2012;18(5):532–8. https://doi.org/10.1002/lt.23396.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Vargas HE, Laskus T, Wang LF, Lee R, Radkowski M, Dodson F, et al. Outcome of liver transplantation in hepatitis C virus-infected patients who received hepatitis C virus-infected grafts. Gastroenterology. 1999;117(1):149–53.

    Article  CAS  PubMed  Google Scholar 

  18. 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(11):1265–72. https://doi.org/10.1097/TP.0b013e318219eb8f.

    Article  PubMed  Google Scholar 

  19. Abbott KC, Bucci JR, Matsumoto CS, Swanson SJ, Agodoa LY, Holtzmuller KC, et al. Hepatitis C and renal transplantation in the era of modern immunosuppression. J Am Soc Nephrol. 2003;14(11):2908–18.

    Article  PubMed  Google Scholar 

  20. Singh N, Neidlinger N, Djamali A, Leverson G, Voss B, Sollinger HW, et al. The impact of hepatitis C virus donor and recipient status on long-term kidney transplant outcomes: University of Wisconsin experience. Clin Transpl. 2012;26(5):684–93. https://doi.org/10.1111/j.1399-0012.2011.01583.x.

    Article  Google Scholar 

  21. Kim WR, Lake JR, Smith JM, Schladt DP, Skeans MA, Harper AM, et al. OPTN/SRTR 2016 annual data report: liver. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2018;18(Suppl 1):172–253. https://doi.org/10.1111/ajt.14559.

    Article  Google Scholar 

  22. Northup PG, Intagliata NM, Shah NL, Pelletier SJ, Berg CL, Argo CK. Excess mortality on the liver transplant waiting list: unintended policy consequences and Model for End-Stage Liver Disease (MELD) inflation. Hepatology. 2015;61(1):285–91. https://doi.org/10.1002/hep.27283.

    Article  PubMed  Google Scholar 

  23. Iakova P, Awad SS, Timchenko NA. Aging reduces proliferative capacities of liver by switching pathways of C/EBPalpha growth arrest. Cell. 2003;113(4):495–506.

    Article  CAS  PubMed  Google Scholar 

  24. Ishak K, Baptista A, Bianchi L, Callea F, De Groote J, Gudat F, et al. Histological grading and staging of chronic hepatitis. J Hepatol. 1995;22(6):696–9.

    Article  CAS  PubMed  Google Scholar 

  25. Hart A, Smith JM, Skeans MA, Gustafson SK, Wilk AR, Robinson A, et al. OPTN/SRTR 2016 annual data report: kidney. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2018;18(Suppl 1):18–113. https://doi.org/10.1111/ajt.14557.

    Article  Google Scholar 

  26. KDIGO clinical practice guidelines for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease. Kidney Int Suppl 2008(109):S1–99. doi:https://doi.org/10.1038/ki.2008.81.

  27. Rao PS, Schaubel DE, Guidinger MK, Andreoni KA, Wolfe RA, Merion RM, et al. A comprehensive risk quantification score for deceased donor kidneys: the kidney donor risk index. Transplantation. 2009;88(2):231–6. https://doi.org/10.1097/TP.0b013e3181ac620b.

    Article  PubMed  Google Scholar 

  28. •• Sibulesky L, Kling CE, Blosser C, Johnson CK, Limaye AP, Bakthavatsalam R, et al. Are we underestimating the quality of aviremic hepatitis C-positive kidneys? Time to reconsider. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant. Surgeons. 2018;18(10):2465–72. https://doi.org/10.1111/ajt.14701 Strong data, recommending revision of the KDRI.

    Article  CAS  Google Scholar 

  29. Durand CM, Bowring MG, Brown DM, Chattergoon MA, Massaccesi G, Bair N, et al. Direct-acting antiviral prophylaxis in kidney transplantation from hepatitis C virus-infected donors to noninfected recipients: an open-label nonrandomized trial. Ann Intern Med. 2018;168(8):533–40. https://doi.org/10.7326/M17-2871.

    Article  PubMed  PubMed Central  Google Scholar 

  30. de Vera ME, Volk ML, Ncube Z, Blais S, Robinson M, Allen N, et al. Transplantation of hepatitis C virus (HCV) antibody positive, nucleic acid test negative donor kidneys to HCV negative patients frequently results in seroconversion but not HCV viremia. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2018;18(10):2451–6. https://doi.org/10.1111/ajt.15031.

    Article  Google Scholar 

  31. Konig V, Bauditz J, Lobeck H, Lusebrink R, Neuhaus P, Blumhardt G, et al. Hepatitis C virus reinfection in allografts after orthotopic liver transplantation. Hepatology. 1992;16(5):1137–43.

    CAS  PubMed  Google Scholar 

  32. Garcia-Retortillo M, Forns X, Feliu A, Moitinho E, Costa J, Navasa M, et al. Hepatitis C virus kinetics during and immediately after liver transplantation. Hepatology. 2002;35(3):680–7. https://doi.org/10.1053/jhep.2002.31773.

    Article  PubMed  Google Scholar 

  33. Berenguer M, Ferrell L, Watson J, Prieto M, Kim M, Rayon M, et al. HCV-related fibrosis progression following liver transplantation: increase in recent years. J Hepatol. 2000;32(4):673–84.

    Article  CAS  PubMed  Google Scholar 

  34. Cortesi PA, Mantovani LG, Ciaccio A, Rota M, Mazzarelli C, Cesana G, et al. Cost-effectiveness of new direct-acting antivirals to prevent post-liver transplant recurrent hepatitis. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2015;15(7):1817–26. https://doi.org/10.1111/ajt.13320.

    Article  CAS  Google Scholar 

  35. Belli LS, Berenguer M, Cortesi PA, Strazzabosco M, Rockenschaub SR, Martini S, et al. Delisting of liver transplant candidates with chronic hepatitis C after viral eradication: a European study. J Hepatol. 2016;65(3):524–31. https://doi.org/10.1016/j.jhep.2016.05.010.

    Article  PubMed  Google Scholar 

  36. Belli LS, Duvoux C, Berenguer M, Berg T, Coilly A, Colle I, et al. ELITA consensus statements on the use of DAAs in liver transplant candidates and recipients. J Hepatol. 2017;67(3):585–602. https://doi.org/10.1016/j.jhep.2017.03.006.

    Article  CAS  PubMed  Google Scholar 

  37. Jimenez-Perez M, Gonzalez-Grande R, Rando-Munoz FJ. Management of recurrent hepatitis C virus after liver transplantation. World J Gastroenterol. 2014;20(44):16409–17. https://doi.org/10.3748/wjg.v20.i44.16409.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. •• Levitsky J, Verna EC, O’Leary JG, Bzowej NH, Moonka DK, Hyland RH, et al. Perioperative Ledipasvir-Sofosbuvir for HCV in liver-transplant recipients. N Engl J Med. 2016;375(21):2106–8. https://doi.org/10.1056/NEJMc1611829 Important data proving efficacy of post-transplant DAA therapy in HCV+ patients receiving HCV-liver allografts.

    Article  PubMed  Google Scholar 

  39. Berenguer M, Agarwal K, Burra P, Manns M, Samuel D. The road map toward an hepatitis C virus-free transplant population. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2018;18(10):2409–16. https://doi.org/10.1111/ajt.14976.

    Article  CAS  Google Scholar 

  40. Chan C, Schiano T, Agudelo E, Paul Haydek J, Hoteit M, Laurito MP, et al. Immune-mediated graft dysfunction in liver transplant recipients with hepatitis C virus treated with direct-acting antiviral therapy. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2018;18(10):2506–12. https://doi.org/10.1111/ajt.15053.

    Article  CAS  Google Scholar 

  41. Bari K, Luckett K, Kaiser T, Diwan T, Cuffy M, Schoech MR, et al. Hepatitis C transmission from seropositive, nonviremic donors to non-hepatitis C liver transplant recipients. Hepatology. 2018;67(5):1673–82. https://doi.org/10.1002/hep.29704.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank Diana Almader-Douglas, M.L.S, Mayo Clinic Arizona medical librarian, for her assistance and dedication.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA

    Blanca C. Lizaola-Mayo, Hugo E. Vargas & David M. Chascsa

  2. Transplant Center, Mayo Clinic, Phoenix, AZ, USA

    Blanca C. Lizaola-Mayo, Hugo E. Vargas & David M. Chascsa

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  1. Blanca C. Lizaola-Mayo
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Correspondence to David M. Chascsa.

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Conflict of Interest

Hugo E. Vargas reports grants from Conatus Pharmaceuticals, grants from Malinkrodt, grants from Griffols, other from Transmedics, and other from American Journal of Gastroenterology, outside the submitted work. Blanca C. Lizaola-Mayo and David M. Chascsa each declare no potential conflicts of interest.

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Lizaola-Mayo, B.C., Vargas, H.E. & Chascsa, D.M. Hepatitis C-Positive Organs for Liver and Kidney Transplantation—Emerging Data and Current Management Strategies. Curr Hepatology Rep 18, 228–232 (2019). https://doi.org/10.1007/s11901-019-00465-1

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