Temporal Changes and Regional Variation in Acceptance of HCV-viremic Livers.

The high efficacy of current hepatitis C virus (HCV) therapy and increased numbers of HCV-infected deceased donors have changed the paradigm of HCV in liver transplant (LT). Modeling studies have been performed to evaluate the optimal timing of HCV treatment (pre- vs post-LT) in HCV-infected patients, and to assess the cost-effectiveness of transplanting HCV-infected livers into HCV-negative patients. However, these models rely on historical data and have not quantified the temporal changes in the median MELD score at transplant of recipients of an HCV-infected liver across geographic areas. We performed a retrospective cohort study of OPTN/UNOS data of non-status 1 deceased donor LT recipients from 1/1/16-12/31/18 and calculated the difference in allocation MELD score in recipients of HCV nucleic acid test (NAT)- vs NAT+ livers by year and UNOS region. We used Pearson correlation coefficients to assess the relationship between MELD score difference in recipients of HCV NAT+ vs HCV NAT- livers and the proportion of non-HCV recipients of HCV NAT+ livers. Nationally, the allocation MELD score difference at LT in recipients of HCV NAT+ vs NAT- livers did not change (4-point difference). This stability was seen in regions 3, 5, 10. In regions 1, 7, 8, 9, 11, the MELD score difference decreased - a diminishing advantage, while in regions 2, 4 increased - a rising advantage. In 2018, recipients of HCV NAT+ livers had a lower MELD score in 9/11 regions and the MELD score advantage of accepting HCV NAT+ livers was moderately inversely correlated with their regional use in non-HCV patients (r=-0.53). These data should be used to inform clinicians of the pre- and post-LT trade-offs of HCV treatment.