Pancreas transplantation from hepatitis C viremic donors to uninfected recipients

• Published in: American journal of transplantation Vol. 21; no. 5; pp. 1931 - 1936
• Main Authors: Lonze, Bonnie E., Baptiste, Gillian, Ali, Nicole M., Dagher, Nabil N., Gelb, Bruce E., Mattoo, Aprajita, Soomro, Irfana, Tatapudi, Vashista S., Montgomery, Robert A., Stewart, Zoe A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01-05-2021
• Subjects: Allografts; Blood & organ donations; clinical research / practice; Donors; donors and donation: deceased; Graft rejection; Hepacivirus; Hepatitis; Hepatitis C; Humans; infection and infectious agents ‐ viral: hepatitis C; infectious disease; Kidney transplants; organ allocation; organ procurement and allocation; Pancreas; pancreas / simultaneous pancreas‐kidney transplantation; Pancreas Transplantation; Pancreas transplants; Scientific Registry for Transplant Recipients (SRTR); Tissue Donors; Transplants & implants; Viremia; Xenografts; pancreas / simultaneous pancreas-kidney transplantation; infectious disease; infection and infectious agents - viral: hepatitis C; organ procurement and allocation; donors and donation: deceased; clinical research / practice; organ allocation; Scientific Registry for Transplant Recipients (SRTR)
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.16465

Despite utilization of hepatitis C viremic organs for hepatitis C naïve recipients (HCV D+/R‐) in other solid organ transplants, HCV viremic pancreata remain an unexplored source of donor organs. This study reports the first series of HCV D+/R‐ pancreas transplants. HCV D+/R‐ had shorter waitlist times compared to HCV D‐/R‐, waiting a mean of 16 days from listing for HCV‐positive organs. HCV D+/R‐ had a lower match allocation sequence than HCV D‐/R‐, and this correlated with receipt of organs with a lower Pancreas Donor Risk Index (PDRI) score. All HCV D+/R‐ had excellent graft function with a mean follow‐up of 438 days and had undetectable HCV RNA levels by a mean of 23 days after initiation of HCV‐directed therapy. The rates of infectious complications, reoperation, readmission, rejection, and length of stay were not impacted by donor HCV status. A national review of potential ideal pancreas donors found that 37% of ideal HCV‐negative pancreas allografts were transplanted, compared to only 5% of ideal HCV‐positive pancreas allografts. The results of the current study demonstrate the safety of accepting HCV‐positive pancreata for HCV‐naïve recipients and advocates for increased utilization of ideal HCV‐positive pancreas allografts.
Transplantation of hepatitis C viremic pancreata into hepatitis C naïve recipients yield excellent outcomes.