HCV+ Organs Offer Better Waitlist, Survival Outcomes for Transplantation

New research has found that people waitlisted to receive hepatitis C virus (HCV)+ organs for transplant have better survival outcomes compared to people not listed to receive these organs, who are at a disadvantage in waitlist outcomes.¹

“There remains a substantial supply-demand mismatch in liver transplantation with a growing need for organ availability. Efforts to expand the donor pool to combat this issue have prompted consideration of extended criteria donors. Initially, HCV + donor livers were either discarded or primarily used for transplantation in HCV nucleic acid amplification test (NAT)+ recipients due to concerns for transmission and graft loss. Since the development of direct-acting antiviral agents (DAA), utilization of HCV NAT+ organs has expanded for HCV NAT- recipients,” lead investigator Natalia Salinas Parra, MD, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and colleagues wrote.¹ “DAA therapies have optimal tolerability, safety, and efficacy when compared to prior interferon-based therapies to treat HCV. With the resulting decline in chronic HCV-related liver transplants and the broadening of the donor pool, DAA have changed the landscape of liver transplantation.”

Parra and colleagues evaluated trends in HCV NAT+ listing and impact on transplant probability, waitlist mortality, and likelihood of receiving HCV NAT+ organs in adult patients in the United Network for Organ Sharing dataset waitlisted for liver transplantation from 2016 to 2023.

The analysis included 21,776 patients initially listed for HCV NAT+ organs and 45,378 not. During this time, the proportion of waitlisted patients listed for these organs increased significantly from 8.8% to 60.8%, (P <.001). In 2021 to 2023, HCV NAT+ listing was associated with a waitlist mortality benefit (SHR 0.73 [95% CI, 0.68-0.79]; P <.001) and a 17% reduced hazard of overall mortality (HR 0.83 [95% CI, 0.78-0.89]; P <.001). A portion of the total protective effect on overall survival (16.0%) was associated with actual receipt of HCV NAT+ organs (TERERI of -0.160 and a PIE of -0.026; P <.001). Patients not listed for HCV NAT+ organs face a relative disadvantage in terms of waitlist outcomes.¹

“In conclusion, while HCV NAT+ listings have risen substantially over time, there remains center-level and geographic variation in this practice, in addition to marginalized groups who are less likely to be listed for these organs. This is a critical issue to explore, as our analyses suggest that in the modern era of transplantation patients who do not agree to HCV NAT+ listing are relatively disadvantaged in terms of transplantation probability and waitlist mortality reduction. Future research should explore patient and provider/factors that contribute to low rates of HCV NAT+ listing as this may elucidate targeted interventions to promote equity in transplant,” Parra and colleagues concluded.¹

Other recent research into liver transplantation found that a direct alcohol biomarker, phosphatidylethanol (PEth), could positively impact the surveillance of alcohol use after liver transplantation in patients with alcohol-related liver disease (ALD). An analysis found that PEth use could provide rapid and early detection of alcohol use among those transplanted for ALD— a population of 46 patients with ≥1 alcohol relapse episode revealed approximately 76% detected by PEth alone.²

REFERENCES

1. Parra NS, Hoteit MA, Rattan P, Abt P, Mahmud N. Trends in candidate HCV NAT+ listing and associated impacts on liver transplantation waitlist outcomes. Am. J. Transplant. Published online October 24, 2024. doi: 10.1016/j.ajt.2024.10.016

2. De La Torre SA, Ibrahim B, Meneses K, Saab S, Shetty A. Impact of phosphatidylethanol in the surveillance for alcohol use in post-liver transplant population: A retrospective study. Alcohol Clin Exp Res (Hoboken). 2024 Oct 31. doi: 10.1111/acer.15474. Epub ahead of print. PMID: 39482857.