Changes in Utilization and Discard of Hepatitis C-Infected Donor Livers in the Recent Era

Abstract

The impact of interferon (IFN)-free direct-acting antiviral (DAA) hepatitis C virus (HCV) treatments on utilization and outcomes associated with HCV-positive deceased donor liver transplantation (DDLT) is largely unknown. Using the Scientific Registry of Transplant Recipients, we identified 25 566 HCV-positive DDLT recipients from 2005 to 2015 and compared practices according to the introduction of DAA therapies using modified Poisson regression. The proportion of HCV-positive recipients who received HCV-positive livers increased from 6.9% in 2010 to 16.9% in 2015. HCV-positive recipients were 61% more likely to receive an HCV-positive liver after 2010 (early DAA/IFN era) (aRR:_1.45 1.61_1.79 , p < 0.001) and almost three times more likely to receive one after 2013 (IFN-free DAA era) (aRR:_2.58 2.85_3.16 , p < 0.001). Compared to HCV-negative livers, HCV-positive livers were 3 times more likely to be discarded from 2005 to 2010 (aRR:_2.69 2.99_3.34 , p < 0.001), 2.2 times more likely after 2010 (aRR:_1.80 2.16_2.58 , p < 0.001) and 1.7 times more likely after 2013 (aRR:_1.37 1.68_2.04 , p < 0.001). Donor HCV status was not associated with increased risk of all-cause graft loss (p = 0.1), and this did not change over time (p = 0.8). Use of HCV-positive livers has increased dramatically, coinciding with the advent of DAAs. However, the discard rate remains nearly double that of HCV-negative livers. Further optimization of HCV-positive liver utilization is necessary to improve access for all candidates.

Keywords: clinical research/practice; donors and donation: deceased; infection and infectious agents; infectious disease; liver transplantation/hepatology; viral: hepatitis C.

Figure 1

Percent of HCV+ liver transplant recipients who received an HCV+ liver each year.

Figure 2

(a) Center level change in percent of HCV+ recipients who received an HCV+ liver in the IFN-free DAA era (Dec. 6, 2013– Dec. 31, 2015) compared to the IFN era (Jan. 1, 2005 – Dec. 5, 2013) and (b) Center level percent of HCV+ recipients who received an HCV+ liver in the IFN-free DAA era.

Figure 3. Percent of HCV+ and HCV− allografts discarded each year

HCV+ livers were 3 times more likely to be discarded than HCV− livers in the IFN-only era (Jan. 1, 2005 – Dec. 31, 2010), 2.2 times more likely in the early DAA/IFN era (Jan. 1, 2011 – Dec. 5, 2013), and 1.7 times more likely in the IFN-free DAA era (Dec. 6 2013–Dec. 31, 2015). HCV+ livers were less likely to be discarded in the early DAA/IFN era and IFN-free DAA eras when compared to the IFN-only era (p-value of interaction terms ≤0.002).