DCD Hepatitis C Virus-positive Donor Livers Can Achieve Favorable Outcomes with Liver Transplantation and Are Underutilized

Background. Hepatitis C virus (HCV)-positive donors (antibody-positive [Ab⁺] or nucleic acid test positive [NAT⁺] donors) have been underutilized. The aim of this study was to evaluate the utilization of livers from HCV-positive with donation after circulatory death (DCD) and to assess outcomes in recipients of these grafts. Methods. Data between 2015 and 2019 were obtained from the United Network for Organ Sharing database. The utilization rates and graft survival among 8455 DCD liver and nonliver donors and 2278 adult DCD liver transplantation (LT) recipients were reviewed on the basis of donor HCV Ab/NAT status. Results. The utilization of Ab⁺/NAT^-donors <40 y and Ab⁺/NAT⁺donors ≥40 y was low than utilization of HCV-negative donors (P < 0.001). Multivariate analysis identified HCV status (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.06-2.48 in Ab⁺/NAT^-, and OR, 1.49; 95% CI, 1.09-2.05 in Ab⁺/NAT⁺) as an independent predictor of nonutilization of liver grafts. The rate of significant liver fibrosis was comparable in Ab⁺/NAT^-(3.5%; P = 0.84) but was higher in Ab⁺/NAT⁺(8.7%; P = 0.03) than that in Ab^-/NAT^-donors. Kaplan-Meier survival curves demonstrated comparable 3-y patient survival in recipients of HCV-positive grafts compared with recipients of HCV-negative grafts (P = 0.63; 85.6% in Ab^-/NAT^-, 80.4% in Ab⁺/NAT^-, and 88.7% in Ab⁺/NAT⁺). Conclusions. Patient and graft survival rates are similar between HCV-positive and HCV-negative DCD LT. However, HCV-positive donors are particularly underutilized for DCD LT.