title: Changes in Utilization and Discard of Hepatitis C-Infected Donor Livers in the Recent Era.
abstract: 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.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: M G
authors.initials: MG
authors.lastname: Bowring
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.|Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
authors.forename: L M
authors.initials: LM
authors.lastname: Kucirka
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.|Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
authors.forename: A B
authors.initials: AB
authors.lastname: Massie
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: X
authors.initials: X
authors.lastname: Luo
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: A
authors.initials: A
authors.lastname: Cameron
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: M
authors.initials: M
authors.lastname: Sulkowski
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: K
authors.initials: K
authors.lastname: Rakestraw
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: A
authors.initials: A
authors.lastname: Gurakar
authors.affiliation: Department of Epidemiology and Biostatistics, George Washington University School of Public Health, Washington, DC.
authors.forename: I
authors.initials: I
authors.lastname: Kuo
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.|Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.|Scientific Registry of Transplant Recipients, Minneapolis, MN.
authors.forename: D L
authors.initials: DL
authors.lastname: Segev
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.|Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: C M
authors.initials: CM
authors.lastname: Durand
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D016174:Hepacivirus / Q000302:isolation & purification*; D006526:Hepatitis C / Q000188:drug therapy / Q000601:surgery* / Q000821:virology; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D066027:Transplant Recipients; D019737:Transplants / Q000821:virology*; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult
chemical_list: D000998:Antiviral Agents
keywords: clinical research/practice; donors and donation: deceased; infection and infectious agents; infectious disease; liver transplantation/hepatology; viral: hepatitis C