CINCINNATI—A researcher at the University of Cincinnati (UC) College of Medicine says livers from hepatitis C patients who test positive for the antibody made to fight the disease may pose a modest risk of infection and be acceptable for transplantation.
Khurram Bari, MD, assistant professor in the UC Division of Digestive Diseases, looked at 25 organ recipients at UC Medical Center who were tested before and after they received a liver from a donor positive for the hepatitis C virus (HCV) antibody, but without evidence of active infection in the blood, and found only four, or 16 percent, contracted HCV after transplantation.
Three of those four recipients who contracted HCV were treated with direct-acting antiviral therapy, while a fourth recipient died from complications brought on by pulmonary hypertension precluding treatment. The patients were seen between March 2016 and March 2017.
"All donors with hepatitis C are not the same; they don’t have the same risk of infection transmission,” says Bari, also a UC Health physician.
The findings were presented by Bari at the American Association for the Study of Liver Diseases during its annual conference, The Liver Meeting, held October 20-24, 2017, in Washington, DC.
Nationally, about 18,000 patients annually are in need of a liver transplant, says Bari. About 7,500 annually receive a liver and close to 15 percent of the patients on the waitlist die before receiving an organ donation. Increasing the pool of available organs for liver transplantation is a necessity, explains Bari.
In 2016, UC Medical Center performed 107 liver transplants, according to Bari.
Bari says that until 2015, physicians had only one test available for HCV liver donors and it detected antibodies created to combat hepatitis C. The test, however, could offer a false positive or a positive result for patients who may have had hepatitis C at some point and been treated or cured. The antibodies would remain, but the individual is no longer infectious, explains Bari.
The United Network for Organ Sharing (UNOS) has mandated that if a donor tests positive for the HCV antibody a second test, the serum nucleic acid test (NAT), must also be used to determine if the hepatitis C virus is active in the donor’s blood. Donors with active HCV have a 100 percent chance to transmitting the virus to a transplant recipient.
"If these donors are positive for antibodies but they have negative NAT results they will have a much lower risk of transmission,” says Bari.
For transplant recipients who do contract HCV, treatments have improved in recent years. Bari says HCV can be cured through a regimen of medication that can cost about $40,000. The costs of the average liver transplant can exceed $500,000, according to UNOS.
"You can’t live without a liver, while hepatitis C is a treatable disease,” says Bari. "This study was conducted with a limited number of participants and its findings, while promising may require more research to ensure the use of these organs from HCV donors pose a very low risk of transmission. Our results should still be given serious consideration in light of our very real need to increase the number of livers available for transplant.”
Bari says a recent study from 2016 based on the UNOS database suggest that up to 200 HCV antibody positive, NAT negative livers nationally might be available annually for transplantation.
Other researchers at UC participating in the study include Tiffany Kaiser, MD, Michael Schoech, MD, Nadeem Anwar, MD, Kamran Safdar, MD, Madison Cuffy, MD, Tayyab Diwan, MD, Flavio Paterno, MD, and Shimul Shah, MD.