Hepatitis C-positive liver transplantation: outcomes and current practice

Purpose of review The coincidence of the opioid epidemic and the approval of direct-acting antivirals for the treatment of hepatitis C virus (HCV) has resulted in an imbalance in HCV viraemic donors relative to HCV viraemic patients awaiting liver transplantation. Although ethical concerns exist about knowingly infecting patients with HCV in the absence of prospective, protocolized studies, transplantation of HCV-positive liver allografts into HCV-negative recipients has increased exponentially in recent years. For this reason, we sought to review outcomes, cost-effectiveness and ethical concerns associated with this practice. Recent findings Short-term outcomes in terms of patient and graft survival are equivalent to those who received HCV-negative allografts without an increase in acute rejection, biliary or vascular complications. Few cases of treatment failure have been reported and complications related to the virus itself such as fibrosing cholestatic hepatitis and membranous glomerulonephritis are rare and reversible with prompt direct-acting antiretroviral treatment. The practice appears cost-effective and modelling suggests a survival benefit for patients willing to accept HCV-positive organs compared with those who do not. In light of the preponderance of current data, one could argue it is unethical to withhold HCV-positive grafts from HCV-negative recipients who have undergone thorough informed consent.

Automated summary

Transplanting HCV-positive liver allografts into HCV-negative recipients has shown equivalent short-term outcomes in terms of patient and graft survival compared to those who received HCV-negative allografts, without an increase in acute rejection, biliary or vascular complications. Complications related to the virus and treatment failure are rare, and the practice appears to be cost-effective with a potential survival benefit for patients willing to accept HCV-positive organs.Based on current data, it may be considered unethical to withhold HCV-positive grafts from HCV-negative recipients who have given informed consent.