Study: Antiviral drugs may permit the safe transplant of hepatitis C-positive livers

Directly acting antiviral drugs used to treat hepatitis C virus may allow for the safe transplantation of livers from HCV-positive individuals to patients in need of a transplant not infected with the virus, according to a study published in the journal Hepatology.

The availably of directly acting antiviral drugs for HCV in recent years has resulted in post-transplant cure rates greater than 90 percent among HCV-positive patients who receive donor livers. These drugs have also reduced the number of HCV-positive patients who eventually need liver transplants, which has resulted in a greater portion of those on the waiting list for new livers being HCV-negative.

There has also been an increase in the number of possible organ donors who are HCV-positive but otherwise healthy, as the nation's ongoing heroin epidemic is increasing transmission of the virus among younger populations. Livers from HCV-positive individuals are often discarded.

To determine the possible efficacy of antiviral therapy in HCV-negative patients who would hypothetically receive livers from HCV-positive donors, researchers with Massachusetts General Hospital in Boston created a mathematical model to conduct a virtual clinical trial. For the simulation, researchers created profiles of HCV-negative patients on the liver transplant waiting list and developed two scenarios: one that involved waiting for an HCV-negative liver and another where patients received an HCV-positive liver with antiviral therapy.

The simulation determined individuals on the list in greater need of livers due to severity of illness could benefit from livers from HCV-positive donors.

"The availability of donor livers continues to be the limiting factor in increasing the number of liver transplant surgeries," said Jagpreet Chhatwal, PhD, senior scientist with the MGH Institute for Technology Assessment and the lead author of the study. "Our study shows that transplanting HCV-positive livers into HCV-negative patients and treating with new antivirals can reduce waiting time to transplant and improve overall life expectancy."

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