Varying Utilization Rates but Superior Outcomes in Liver Transplantation From Hepatitis C-positive Donors in the United States: An Analysis of the OPTN/UNOS Database

Background. Liver transplantation (LT) from hepatitis C virus (HCV)-positive donors [antibody positive (Ab+) or nucleic acid test-positive (NAT+) donors] has been reported to achieve successful outcomes. However, donor and recipient selection has not been well-characterized. Methods. Data between 2015 and 2019 were obtained from the United Network for Organ Sharing database. The utilization rates and graft survival among 35 239 potential donors and 23 780 adult LT recipients were reviewed based on donor HCV Ab/NAT status. Results. The utilization of Ab+/NAT+ donors was significantly reduced compared with HCV-negative donors (66.4% versus 80.0%, P < 0.001) among donors aged between 40 and 69 y. Recipients of livers from HCV-positive donors had lower laboratory and allocation Model for End-stage Liver Disease scores (both P < 0.001). HCV-positive donors were younger (P < 0.001). Kaplan-Meyer survival curves demonstrated significantly superior 1-y graft survival in recipients of HCV-positive grafts compared with those from HCV-negative grafts (P = 0.004; 97.1% in Ab-/NAT+, 93.9% in Ab+/NAT-, and 93.7% in Ab+/NAT+ versus 91.8% in Ab-/NAT-). Multivariate analysis for 1-y graft survival identified donor age [hazard ratio (HR) = 1.01; 95% confidence interval (CI), 1.00-1.01] and laboratory Model for End-stage Liver Disease score (HR = 1.01; 95% CI, 1.00-1.01) as independent predictors but not donor HCV status: HR 0.77, 95% CI, 0.58-1.02 in Ab+/NAT-; HR 0.82, 95% CI, 0.66-1.03 in Ab+/NAT+; and HR 0.39, 95% CI, 0.10-1.55 in Ab-/NAT+. Conclusions. More widespread utilization of HCV-positive donors, especially Ab+/NAT+ donors of age 40-69 y, may expand the donor pool without impairing short-term outcomes after LT.