Study Demonstrates Patient, Graft Survival of HCV-Positive DCD Donor Liver Grafts

Liver grafts from hepatitis C virus (HCV)-positive donation after circulatory death (DCD) donors have 1-year patient and graft survival comparable with donation after brain death (DBD) liver grafts from donors with or without HCV infection, according to findings from a recent study.¹

Leveraging data from a single center as well as national data obtained from the United Network for Organ Sharing, the study encourages the widespread use of liver grafts from DCD and HCV-positive donors and standardization of practice in DCD donation to expand the donor pool without compromising short-term outcomes.¹

According to the Organ Procurement and Transplantation Network, more than 100,00 men, women, and children are currently on the national transplant waitlist, with another person added every 8 minutes. As of March 2024, nearly 10,000 patients on the waitlist were seeking a liver transplant, the second highest organ on the waitlist behind kidneys.²

“Because of the persistent organ shortage, efforts have been made to expand the donor pool with increased utilization of organs from older donors, living donor liver transplantation, DCD, and donors with increased infectious risk,” Navdeep Singh, MD, a transplant surgeon and clinical assistant professor of surgery at The Ohio State University Wexner Medical Center, and colleagues wrote.¹

To evaluate organ utilization and outcomes of liver grafts from DCD donors with past or present HCV infection, investigators conducted a national registry analysis using data obtained from the United Network for Organ Sharing Standard Transplant Analysis and Research files for all deceased donor liver transplants performed between November 2016 and December 2021. Additionally, investigators conducted a retrospective analysis of all deceased donor liver transplants performed at their center between November 2016 and December 2021.¹

Living donor liver transplants, split liver transplants, multiorgan transplants, and transplants unable to be assigned donor HCV status or donor DCD/DBD status were excluded from the study. All included transplants were divided into 4 groups: HCV-negative DCD, HCV-negative DBD, HCV-positive DCD, and HCV-positive DBD. The outcome of interest was 1-year graft survival.¹

During the 5 year study period, a total of 146 transplant centers performed liver transplantation in the United States, all of which performed DBD liver transplantation. Of these, liver transplants were not performed from DCD donors, HCV-positive donors, and a combination of DCD and HCV-positive donors by 28.7%, 27%, and 70%–72% of centers, respectively.¹

In multivariate analysis, increasing center acceptance ratio was associated with increased utilization of liver grafts from donors with older age, diabetes, elevated aspartate transaminase values, greater utilization of DCD HCV-negative liver grafts, and DCD HCV antibody-positive nucleic acid test-negative donors.¹

Analysis of the national data revealed 238 HCV-positive DCD, 3053 HCV-negative DCD, 3108 HCV-positive DBD, and 30,664 HCV-negative DBD liver transplants were performed during the study period. Investigators noted donors of HCV-positive DBD grafts were younger compared with HCV-negative DBD and the HCV-positive DCD grafts were younger compared with HCV-negative DCD (P <.0001). Additionally, 40% of all DBD grafts, 37% of HCV-positive DCD grafts, and 31% of HCV-negative DCD grafts were from female donors (P <.0001).¹

Recipients were younger in the HCV-negative DBD group (P <.0001). Investigators pointed out 31% of recipients who received HCV-positive grafts, 32% who received HCV-negative DCD grafts, and 36% who received HCV-negative DBD grafts were female (P <.0001).¹

Investigators noted 1-year graft survival of HCV-negative DCD liver grafts was lower compared with other groups (89% vs 92% HCV-positive DCD vs 93% HCV-positive DBD vs 92% HCV-negative DBD; log-rank P <.0001), whereas 1-year patient survival did not differ between groups (log-rank P = .5659).¹

Analysis of the single-center data showed during the study period, 569 deceased donor liver transplants were performed, with 40 HCV-positive DCD, 126 HCV-negative DCD, 92 HCV-positive DBD, and 311 HCV-negative DBD donors. Investigators pointed out HCV-positive donors were younger compared with HCV-negative donors (P = .0475), had lower BMI compared with HCV-negative donors (P = .0012), a greater percentage met CDC high-risk criteria (P <.0001), and a greater percentage were transplanted into HCV AB-positive or NAT-positive recipients (P <.0001).¹

Investigators noted there was no difference in hospital length of stay (P = .7732), readmissions within 1 year, 1-year patient survival (log-rank P = .3281), and 1-year graft survival (log-rank P = .4035).¹

“These results encourage the widespread use of liver grafts from DCD and HCV+ donors, and standardization of practice in DCD donation and use of liver grafts from HCV+ donors may expand the donor pool without compromising short-term outcomes,” investigators concluded.¹

References

1. ^{Punjala SR, Logan AJ, Subramanian J, et al. Outcomes of Liver Transplantation From Hepatitis C Virus–positive DCD Donors and Its Utilization Among Centers in the United States. Transplantation. doi:10.1097/TP.0000000000005174}
2. ^{Health Resources and Services Administration. Organ Donation Statistics. March 2024. Accessed August 23, 2024. https://www.organdonor.gov/learn/organ-donation-statistics}