Transplantation from hepatitis-C (HCV) positive donors to negative recipients

In a study from Toronto, donor lungs were transplanted from
HCV positive donors to 22 HCV negative recipients. Before
transplantation donor lungs were treated with ex-vivo lung
perfusion (EVLP) with or without ultraviolet (UVC) perfusate
irradiation. All patients with viremia (n=20) received 12 weeks
of sofosbuvir and velpatasvir starting at least two weeks after
transplantation. Viral loads in recipients who had donor lungs
that were treated with both EVLP and UVC were significantly
lower than in those who had been treated with EVLP only. In
two patients whose lungs had been treated with both EVLP
and UVC no transmission occurred. The primary endpoint was
survival and HCV-free status at six months was achieved by
19/22 (86 %). One patient who did not develop HCV infection
died at day 31 from multiple organ failure. 2 patients had HCV
relapse and were retreated

Ref; Cypel et al. Lancet Respir Med. 2019;doi: 10.1016/S2213-2600(19)30268-1

Comment: Is it acceptable to transmit HCV in organ transplantation?
With the excellent treatment results with directly
acting antivirals (DAAs) it seems reasonable to use HCV-positive
donors if there is a shortage of organs and a transplant may
be lifesaving. Even in immunologically suppressed transplant
recipients treatment with DAAs is effective without major side
effects.