223.2 Use of hepatitis C positive donors - Con

Jay Fishman, United States

Professor of Medicine
Infectious Disease and Transplant Center, Massachusetts General Hospital
Harvard Medical School

Overview

The shortage of organs for transplantation has increased utilization of organs from donors potentially or known to be from donors carrying various infections.  Our data has shown that careful use of US PHS increased risk donation is safe as long as recipients are carefully monitored after transplantation. Use of HCV-positive organs requires development of both a safety infrastructure and a research program in advance to avoid undetected transmission, to recognize reactivation of hepatitis B virus and of HCV following HCV-antiviral therapies (DAA failures), to detect premature liver graft failures or excess opportunistic infections (if any), and to study any shifts in risk for recurrence of hepatocellular carcinoma in liver recipients.  Successes to date in the use of HCV-infected grafts should not prevent development of knowledge regarding the limitations of this technology. 

Objectives

The participant will understand the gaps in the knowledge regarding the efficacy of DAA therapy:

  • HCV transmission may occur in NAT-negative, seropositive liver donors (but not kidneys)
  • Viable virus may persist in liver after DAA therapy (DAA do not induce intracellular antiviral state produced by interferon therapy). 
  • Tracking of immunosuppressed recipients of HCV+ organs or organ recipients after DAA therapy is essential. 



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