The use of direct-acting antivirals (DAA)in treating hepatitis C virus (HCV) has both altered the frequency and outcome of liver transplantation (LT), but also creates a rationale for using HCV RNA-positive donors, including into HCV-negative recipients. The authors were interested in the frequency of organ utilisation and graft survival in recipients of HCV RNA positive donors. They collected data from the Scientific Registry of Transplant Recipients (SRTR) on adult patients who underwent a primary, single-organ, deceased donor LT between 2008 and 2018, and compared the outcomes of HCV-negative recipients (R-) who received an allograft from donors who were HCV RNA positive (DNAT+) with those whose donors were HCV RNA negative (DNAT-). The authors identified 11,270 DNAT-/R-, 4748 DNAT-/R+, 87 DNAT+/R- and 753 DNAT+/R+ patients from the registry, with the following 2-year graft survival rates across the groups: DNAT-/R- 88%, DNAT-/R+ 88%, DNAT+/R- 86% and DNAT+/R+ 90%. In addition, there were 2635 LTs using HCV antibody-positive donors (DAb+): 2378 DAb+/R+ and 257 DAb+/R-. The annual number of DAb+/R- transplants performed increased from seven in 2008 to 107 in 2017. During the DAA era, graft survival improved for all recipients, with 3-year survival of DAb+/R- patients and DAb+/R+ patients increasing to 88% from 79%, and to 85% from 78%, respectively. Therefore, following the introduction of DAAs, there has been increased utilisation of HCV-viraemic donor livers, including the transplantation of HCV-viraemic livers into HCV-negative recipients.
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