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:1.451.611.79, p < 0.001) and almost three times more likely to receive one after 2013 (IFN-free DAA era) (aRR:2.582.853.16, p < 0.001). Compared to HCV-negative livers, HCV-positive livers were 3 times more likely to be discarded from 2005 to 2010 (aRR:2.692.993.34, p < 0.001), 2.2 times more likely after 2010 (aRR:1.802.162.58, p < 0.001) and 1.7 times more likely after 2013 (aRR:1.371.682.04, 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.
In this registry-based study, the authors report that in the era of highly effective antiviral therapies for hepatitis C (HCV), use of HCV+ donor livers has increased, outcomes after HCV+ transplantation are comparable to HCV– transplantation, and yet discard rates of HCV+ livers remain elevated.