Transplantation of HCV RNA-positive donor organs into HCV RNA-negative recipients

Another issue that has emerged is the use of donor organs, including livers, kidneys, hearts and lungs, from HCV-positive donors, which were previously used only in HCV viraemic recipients. Now, and with appropriate consent, HCV viraemic donor livers have been used in HCV-negative recipients in Australia. This strategy has the potential to increase donor organ availability and reduce waiting list times. International experience has shown that HCV-positive donor kidneys, hearts and lungs can also be successfully transplanted into HCV-negative recipients.

When an anti-HCV-positive/HCV RNA-positive donor is used, HCV infection will be transmitted and should be treated with DAAs in the early post-transplant period. Deferring antiviral therapy increases the risk of symptomatic acute hepatitis C infection; cases of FCH have been reported. This is an evolving and complicated area. The optimal timing and duration of DAA therapy in this setting continue to be evaluated.

Transmission from anti-HCV-positive/HCV RNA-negative donors is extremely rare and, where reported, probably reflects acute infection in high-risk donor..

Table 6. Recommended treatment protocols after liver transplantation for hepatitis C virus (HCV) infection in people with compensated liver disease
Regimen	HCV genotype	Duration
Sofosbuvir 400 mg, orally, daily + Velpatasvir 100 mg, orally, daily	1–6	12 weeks
Glecaprevir 300 mg, orally, daily + Pibrentasvir 120 mg, orally, daily	1–6	12 weeks*
Sofosbuvir 400 mg, orally, daily + Velpatasvir 100 mg, orally, daily + Voxilaprevir 100 mg, orally, daily	1–6	12 weeks
* Data supporting the use of glecaprevir + pibrentasvir for 8 weeks in people with no cirrhosis in the post-transplantation setting are limited. Until additional real-world data are available, we continue to recommend a 12-week treatment duration. Treatment for 8 weeks may be considered on a case-by-case basis.