Use of Anti-HCV Positive Grafts in Liver Transplantation

Abstract

The increase in organ demand for liver transplantation has exceeded the supply, resulting in longer waiting periods and higher death rates on the waiting list. As a consequence, most liver transplant centers throughout US and Europe have resorted to using suboptimal donors to expand the donor pool. The most recent papers have reported that the percentage of HCV(+) recipients who are transplanted with HCV(+) donors is more than 10 % of cases. In the near future, it is expected that a larger number of HCV(+) liver transplant candidates will be offered an HCV(+) graft. This means that greater experience on the management of both HCV infection and fibrosis progression will be requested from the transplant hepatologist. At the same time, since the rate of donation has reached a plateau since 2006, it is probable that older donors and grafts with mild-to-moderate steatosis will be used. There is growing evidence showing that the outcome of HCV(+) recipients is not different whether they receive an HCV(+) or an HCV(−) graft in terms of graft and patient survival. However, it is mandatory that liver biopsies of HCV(+) donors must show minimal or likely no fibrosis and minimal inflammation in order to be used for grafting. In this new scenario, the adequacy of the match between donor and recipient may be paramount since a decreased survival might be expected in high-risk patients receiving organs from suboptimal donors. In HCV(+) recipients from HCV(+) donors we should ensure an accepted graft and patient survival with no excessive costs for the transplant community. The benefit of liver transplantation should be evaluated in this subset of the population.