Author information
1
National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and the NIHR Blood and Transplant Research Unit (BTRU)in Organ Donation and Transplantation at the University of Cambridge in collaboration with Newcastle University and in partnership with NHS Blood and Transplant (NHSBT).
2
Organ Donation and Transplantation Directorate, NHS Blood and Transplant.
3
Hepatic-Pancreatico-Biliary Surgical Services and Edinburgh Transplant Unit, Royal Infirmary of Edinburgh.
4
Liver Unit, Queen Elizabeth Hospital, Birmingham.
Abstract
BACKGROUND:
Organs from hepatitis C virus (HCV) seropositive (HCVpos) individuals are seldom used for transplantation because of the risk of disease transmission. Because transmitted HCV is now amenable to effective treatment we estimated the potential impact of using HCVpos deceased donor organs for transplantation.
METHODS:
The Potential Donor Audit (PDA) of patients (<80years) dying in UK critical care units and the UK Transplant Registry (UKTR) was searched to identify HCVpos potential and proceeding deceased donors. Donor organ quality was assessed using validated donor organ quality indices. Cost analysis was performed by comparing the cumulative cost of direct acting antivirals with haemodialysis and renal transplantation.
RESULTS:
Between 2009-2016, 120 patients identified from the PDA were not considered as potential donors because of the presence of HCV. Between 2000-2015, 244 HCVpos potential deceased donors were identified from the UKTR, and 76 (31%) proceeded to donation, resulting in 63 liver, 27 kidney and 2 heart transplants. Recipient and graft survival was not adversely impacted by donor HCVpos status. Most (69%) offered organs were declined because of positive virology although their quality was similar to that of other transplanted organs. The additional costs of treating recipients exposed to HCV by receiving a HCVpos kidney was cost-neutral with dialysis 5 years from transplantation.
CONCLUSIONS:
HCVpos donors represent a potential source of organs for HCVneg recipients as many good quality HCVpos donor organs are not currently used for transplantation. This change in practice may increase access to transplantation without having an adverse effect on transplant outcome.