Risk of Hepatitis C Transmission After Liver Transplantation From Hepatitis C Nonviremic, Antibody-positive Donors Into Nonviremic Recipients in the Era of Mandated Testing.

BACKGROUND

Starting in March 2021, the Organ Procurement and Transplantation Network (OPTN) mandated testing and reporting of hepatitis C virus (HCV), hepatitis B virus, and HIV at 4-8 wk posttransplantation. The aim of this study was to assess the rates of detectable HCV viremia in HCV nucleic acid test (NAT) negative recipients of liver allografts from HCV antibody-positive/NAT-negative (Ab + /NAT - ) donors in a nationwide cohort after the institution of the reporting mandate.

METHODS

Post-liver transplant (LT) HCV viremia and patient/graft outcomes were compared between 2 groups using the OPTN database: HCV negative LT recipients of donors with HCV Ab + /NAT - and HCV Ab - /NAT - between March 2021 and March 2023.

RESULTS

Among 7447 recipients (Ab + /NAT - N = 380 and Ab - /NAT - N = 7067), 5 (1.5%) of Ab + /NAT - LT recipients and 5 (0.09%) of Ab - /NAT - LT recipients reported a positive HCV NAT result during the median follow-up period of 182 (175-199) d post-LT. In this early period of mandated reporting, HCV NAT results at 6 mo posttransplant were available for 85.3% of the Ab + /NAT - group and 77.1% of the Ab - /NAT - group. Overall and graft survival were comparable among the 2 groups at 6 and 12 mo post-LT.

CONCLUSIONS

After the OPTN mandate of HCV testing post-LT starting March 2021, the rate of positive HCV NAT results was 1.5% in HCV NAT - recipients of liver allografts from HCV Ab + /NAT - donors. Improved compliance with the mandated testing can help in the early detection of HCV transmission among LT recipients in this cohort and may help prevent associated post-LT complications.