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Can an HCV carrier be an organ donor?

Can an HCV carrier be an organ donor?. Ri 段培耕 95/11/27. Transmission of HCV via organ transplantation. Anti-HCV(+) donors: New England Organ Bank experience between 1986~1990 NEJM(1991), Lancet(1995) Transmission of hepatitis C virus by organ transplantation

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Can an HCV carrier be an organ donor?

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  1. Can an HCV carrier be an organ donor? Ri 段培耕 95/11/27

  2. Transmission of HCV via organ transplantation • Anti-HCV(+) donors: New England Organ Bank experience between 1986~1990 • NEJM(1991), Lancet(1995) • Transmission of hepatitis C virus by organ transplantation • BJ Pereira, EL Milford, RL Kirkman, and AS Levey • NEJM Volume 325:454-460 August 15, 1991 Number 7

  3. Transmission of hepatitis C virus by organ transplantation • Of 716 organ donors, 13(1.8%) were anti-HCV(+) • 13 HCV(+) donors→ 29 recipients (19 kidneys, 6 hearts, 4 livers) • 14(48%) post-transplantation NANBH • 12 of 13 proved HCV infection • Liver disease began 3.8m(mean) after transplantation • 7.4 times the prevalence (6.5%) after transplantation from untested donors • Liver disease was more frequent in the patients who had received anti-lymphocyte preparations (P = 0.04).

  4. A Controlled Study Of Hepatitis C Transmission By Organ TransplantationPereira, Brian J.G., Wright, Teresa L., Lancet, 0099-5355, February 25, 1995, Vol. 345, Issue 8948 • Study group: 13 anti-HCV(+) →29 recipients • (19 kidneys, 6 hearts, 4 livers) • Control group: 37 anti-HCV(-) → 74 recipients • (57 kidneys, 6 hearts, and 11 livers ) • There was no attempt to match recipients with respect to the type of organ or pre-transplantation characteristics • Median post-transplant follow-up was 42 and 49 months for study and control groups

  5. Pre-transplantation characteristics of recipients

  6. Results

  7. Results

  8. Results

  9. Results • RR of liver disease: 4.4 folds (42~49m f/u) • No increased rejection, graft loss or death • There were significant differences between the two groups in pre-transplantation characteristics such as duration of dialysis and number of previous transplants; however, adjustment for these did not alter the relative risk of post-transplantation NANBH, graft loss, or death.

  10. Other studies • Four years follow up of hepatitis C positive kidneys into hepatitis C negative recipients — Prospective study. • Mendez, R, El-Shahawy, M, Obispo, E, et al. • J Am Soc Nephrol 1995; 6:1105. • 42 anti-HCV(-) recipients of kidneys from anti-HCV(+) donors. • f/u for four years after transplant • The prevalence of liver disease was higher among recipients of positive kidneys • Survival among the two groups did not significantly differ.

  11. Other studies • Transplantation of hepatitis C (HCV) kidneys: Defining the risks • Pirsch, JD, Heisey, D, D'Allesandro, AM, et al. • 14th Annual Meeting of the American Society of Transplant Physicians, Chicago, May 14-17, 1995, p. 98. • Prospective study of transplanted 69 kidneys from anti-HCV(+) donors into anti-HCV(-) recipients • Survival among recipients from anti HCV positive donors was significantly lower than in recipients from anti-HCV negative donors.

  12. Other studies • The impact of transplantation with deceased donor hepatitis c-positive kidneys on survival in wait-listed long-term dialysis patients. • Abbott KC; Lentine KL; Bucci JR; Agodoa LY; Peters TG; Schnitzler MA • Am J Transplant 2004 Dec;4(12):2032-7. • Despite these possible adverse effects, there may be a survival advantage with receiving a kidney from an anti-HCV(+) donor versus remaining on a wait-list. • Among nearly 40,000 USRDS patients awaiting transplantation, transplantation with such a kidney was significantly associated with improved survival versus remaining on a transplant wait list (adjust hazard ratio for death was 0.76).

  13. Discussion • Higher risk of liver disease • No significant adverse effect on rejection, graft loss or patient survival. (except for a few reports) • Longer follow-up might show increased mortality among recipients of organs from anti-HCV(+) donors. • Clinical characteristics of HCV infection in recipients

  14. How about Anti-HCV(+) donors→ Anti-HCV(+) recipients？ • HCV has several distinct variants • six major types, each consists of one or more subtypes, named a, b, c, etc. • Reinfection (new infection after a previous infection has cleared) with the same or different HCV strain • Superinfection (infection with a new HCV strain in the presence of current infection)

  15. How about Anti-HCV(+) donors→ Anti-HCV(+) recipients？ • The clinical implications of superinfection of HCV in transplant recipients are not well defined. It may not have any serious clinical consequences, at least in the short-term. • A study has demonstrated that the type of HCV-infection, single versus mixed does not adversely affect patient survival among renal transplant candidates (at least in the short-term) • One study demonstrated that such practice shortened the waiting time for anti-HCV(+) patients without increasing the rate of rejection episodes, infection complications, graft loss or patient death.

  16. Thank you for your attention!

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