Outcomes of Liver Transplantation From Hepatitis C Virus–positive DCD Donors and Its Utilization Among Centers in the United States

Abstract

Background. Donation after circulatory death (DCD) or hepatitis C virus (HCV+) liver grafts are underused among transplant centers in the United States. The study aimed to evaluate organ utilization and outcomes of liver grafts from DCD donors with HCV infection. Methods. National registry and local center data of all deceased donor liver transplants performed between November 2016 and December 2021 were analyzed. All transplants were divided into 4 groups: HCV– DCD, HCV– donation after brain death [DBD], HCV+ DCD, and HCV+ DBD. The outcome of interest was 1-y graft survival. Results. Out of 146 liver transplant centers in the United States, liver transplants were not performed from DCD donors, HCV+ donors, and a combination of DCD and HCV+ donors by 28.7%, 27%, and 70%–72% of centers, respectively. In multivariate analysis, increasing center acceptance ratio was associated with increased utilization of liver grafts from DCD HCV– and DCD HCV antibody-positive nucleic acid test negative donors. Nationally, 1-y graft survival of HCV– DCD liver grafts was lower compared with other groups (89% versus 92% HCV+ DCD versus 93% HCV+ DBD versus 92% HCV– DBD, log rank P < 0.0001). There was no difference in 1-y graft survival among groups locally. Conclusions. Liver grafts from HCV+ DCD donors have 1-y patient and graft survival comparable with DBD liver grafts from donors with or without HCV infection. These results encourage the widespread use of liver grafts from DCD and HCV+ donors and standardization of practice in DCD donation to expand the donor pool without compromising short-term outcomes.