Transplantation of HCV RNA-positive donor organs into HCV RNA-negative recipients

Another issue that has emerged is the use of donor organs, including livers, kidneys, hearts and lungs, from HCV-positive donors, which were previously used only in HCV viraemic recipients. Now, and with appropriate consent, HCV viraemic donor livers have been used in HCV-negative recipients in Australia. This strategy has the potential to increase donor organ availability and reduce waiting list times. International experience has shown that HCV-positive donor kidneys, hearts and lungs can also be successfully transplanted into HCV-negative recipients.

When an anti-HCV-positive/HCV RNA-positive donor is used, HCV infection will be transmitted and should be treated with DAAs in the early post-transplant period. Deferring antiviral therapy increases the risk of symptomatic acute hepatitis C infection; cases of FCH have been reported. This is an evolving and complicated area.

Transmission from anti-HCV-positive/HCV RNA-negative donors is extremely rare and, where reported, probably reflects acute infection in high-risk donors.

Table 6. Recommended treatment protocols after liver transplantation for hepatitis C virus (HCV) infection in people with compensated liver disease

Regimen

HCV genotype

Duration

Sofosbuvir 400 mg, orally, daily

+

Velpatasvir 100 mg, orally, daily

1–6

12 weeks

Glecaprevir 300 mg, orally, daily

+

Pibrentasvir 120 mg, orally, daily

1–6

12 weeks

Sofosbuvir 400 mg, orally, daily

+

Velpatasvir 100 mg, orally, daily

+

Voxilaprevir 100 mg, orally, daily

1–6

12 weeks

Sofosbuvir 400 mg, orally, daily

+

Ledipasvir 90 mg, orally, daily

1

12 weeks