Best practice recommendations for the use of hepatitis C viremic donor organs for hepatitis C virus naïve recipients. Issue 8 (16th June 2021) - Stewart, Zoe A.
Abstract: The combination of the transplant organ deficit, the increase in HCV nucleic acid positive donors (HCV NAT+), and the development of direct‐acting antiviral agents (DAAs) has resulted in a rapid increase in HCV NAT+ organ transplants into HCV naïve recipients. Early clinical experience with HCV NAT+ donor organs has shown promising outcomes; however, best practices are lacking to guide transplant programs during all phases of patient care. Transplant programs developing protocols for the utilization of HCV NAT+ organs will need a multidisciplinary team to address all aspects of pre‐transplant and post‐transplant patient care. Reports of fibrosing cholestatic hepatitis in HCV NAT+ organ transplant recipients receiving delayed DAA initiation highlight the need for the transplant community to develop safe and effective protocols. A failure to do so will inevitably lead to the erosion of public trust from cases of missed or inadequately treated donor‐derived HCV infections. Herein, we provide best practice guidelines for the utilization of HCV NAT+ organs into HCV‐negative recipients based on literature review and expert opinion from the faculty of the ASTS Standards and Quality Committee.