The Practical Impact of Reactive HCV NAT and Anti-HCV Results: One OPO’s Experience

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BackgroundOne U.S. organ procurement organization (OPO) perceived a high level of discard and low rate of organs transplanted per donor (OTPD) in donors testing positive for HCV. The OPO wished to determine the frequency of such donors and utilization rates of organs from donors testing positive on one or both HCV tests (HCV+).MethodA 15-month review of recovered organ donors and authorized/not recovered donors (ANRs) was performed. Test results, organs recovered, and organs transplanted were analyzed for each donor and ANR.ResultsBetween 1/1/2016 and 3/31/2017, 213 donors were recovered; there were 105 ANRs. During this period, 27 cases tested positive for one or both HCV tests; 1 case was an ME decline and was exempted from analysis leaving 26 cases (8.2%). Of these, 10 (3.2% of all cases, 38.5% of HCV+ cases) were recovered donors, 16 (5.1% of all cases, 61.5% of HCV+ cases) were ANRs. The 10 recovered donors resulted in 20 organs recovered and 8 organs (4 kidneys, 4 livers) transplanted for an OTPD of 0.8 and a discard rate of 60%. Notably, there were 7 HCV+ cases which were anti-HCV+/HCV NAT-; of these 5 were recovered donors (71.4% of cases with discordant results) yielding 9 recovered organs, 1 liver and 0 kidneys transplanted for OTPD of 0.2 and 88.9% discard rate. Also of note there were 5 DCD donors (50% of donors); 2 were positive for both HCV tests, 3 were discordant (HCV NAT-). One of 5 DCD donors (anti-HCV+/HCV NAT-) yielded 1 liver transplanted and 0 kidneys (OTPD = 0.2) and 8 organs (all kidneys) discarded. There was 1 anti-HCV-/HCV NAT+ donor (brain dead) yielding 1 kidney and 1 liver transplanted (OTPD=2.0) with 1 kidney discarded.Discussion/ConclusionsOur data indicate that any positive HCV test results in a high rate of ANR and high likelihood that if recovered there will be a low OTPD and a high discard rate. Antibody positive, NAT negative donors had no better outcome than donors positive for both tests. DCD donors had similar OTPD and discard to brain dead donors; however, no HCV+ DCD kidneys were transplanted (100% discard). We conclude that in the current U.S. acceptance environment, HCV+ DCD donors should only pursue if a center is willing to accept the liver. We further conclude negative HCV NAT provides no placement benefit in an antibody positive donor. We suggest broader evaluation of acceptance practices relative to positive HCV testing.

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