Transplanting hepatitis C virus (HCV)-positive livers into HCV-negative patients with preemptive direct-acting antiviral (DAA) therapy could improve patient survival on the liver transplant (LT) waiting list, a new study suggests. Researchers evaluated whether and in which HCV-negative patients the potential benefit of accepting an HCV-positive organ outweighed the risks associated with HCV allograft infection. Among the details:

• Patients receiving HCV-positive livers were treated preemptively with 12 weeks of DAA therapy and had a higher risk of graft failure than those receiving HCV-negative livers.
• Accepting any liver regardless of HCV status vs accepting only HCV-negative livers resulted in an increase in life expectancy when Model for End-Stage Liver Disease (MELD) was ≥20, with the benefit highest at MELD 28 (0.172 additional life-years).
• The magnitude of clinical benefit was greater in UNOS regions with higher HCV-positive donor rates.