Transplantation of Liver from Hepatitis C-infected Donors to Hepatitis C RNA Negative Recipients: Histological and Virologic Outcome.

Nair, Satheesh P; Marella, Hemnishil K; Maliakkal, Benedict; Snyder, Heather; Handley, Charlotte; Kothadia, Jiten P; Ali, Bilal; Satapathy, Sanjaya K; Molnar, Miklos Z; Clark, Ian; Jain, Richa; Helmick, Ryan; Eymard, Corey; Eason, James D

BACKGROUND The virologic and histologic outcomes of a Hepatitis C virus(HCV) infected liver graft into an HCV negative recipient are not well understood. We aim to evaluate the sustained virologic response (SVR) rate and the liver histology at 1-year post-OLT with an HCV infected graft. METHODS A total of 33 patients received the HCV antibody(Ab)+/Nucleic acid amplification test (NAT)+ graft. Of these patients, 23 were HCV negative recipients, and 10 were HCV positive recipients. The 1-year biopsy data was available for 24 patients: 15 patients in HCV negative group who received an HCV Ab+/NAT+ graft and 9 patients in HCV positive group who received an HCV Ab+/NAT+ graft. Patients with (+) HCV RNA were started on direct-acting antiviral(DAA) treatment approximately 107 days after OLT using either a Glecaprevir-Pibrentasvir or Sofosbuvir-Velpatasvir or Sofosbuvir-Ledipasvir. RESULTS All patients (n=33) were treated with DAA and achieved SVR. The 1-year post-OLT liver-biopsies were available in 24 patients: 9 patients had F1 & F2 fibrosis and 17 patients had minimal to moderate inflammation. There was no statistical difference in fibrosis and inflammation between the HCV negative vs. positive recipients. All patients who received the NAT+ graft developed viremia and subsequently achieved SVR with treatment. CONCLUSION At 1-year protocol liver-biopsy, patients had inflammation consistent with viral hepatitis despite the successful eradication of HCV.