Temporal trends and impact of willingness to accept organs from donors with hepatitis C virus

Direct-acting antivirals (DAA) transformed hepatitis C virus (HCV) treatment in 2014; however, their impact on transplant candidates' willingness to accept (CWTA) organs from HCV+ donors remains uncertain. We retrospectively studied Organ Procurement and Transplantation Network data from 2008 to 2019, investigating CWTA different organs from HCV+ donors over time, using segmented multivariable logistic regression, and how that influenced wait-time and deceased-donor transplantation (DDTx) probability, using multivariable logistic or linear regression. We found that DAA availability was associated with a marked increase in CWTA in all organs from HCV+ donors except intestine. By December 2020, 40% of kidney, 33% of kidney-pancreas, 42% of pancreas, over 50% of liver, heart, lung, heart-lung, and 9% of intestine candidates waitlisted were CWTA an organ from HCV+ donors. Compared with pre-DAA, yearly CWTA kidney from HCV+ donors increased post-DAA (1.78)1.81(1.83)-fold, kidney-pancreas (2).(52) 2.78 (3.07)-fold, pancreas (3.15)3.69 (4.43)-fold, liver (1.53)1.54(1.56)-fold, heart (1).(92) 2.0(2).(08) -fold, and lung (2.00)2.1(2).(20) -fold. CWTA kidney and liver from HCV+ donors significantly increased DDTx probability post-DAA ((1.98)2.04(2.1)-fold and (1.24)1.29(1.33)-fold, respectively) and shortened kidney candidates' wait-time(78)90(101) days (Mean with 95% CI). CWTA organs from HCV+ donors rose significantly with DAA availability, benefitting kidney and liver candidates with increased DDTx rates and shortened kidney candidates' wait time. Further long-term outcomes investigation and standardized organ from HCV+ donors' education could improve both provider and patient acceptance and utilization.