Published online Dec 21, 2019. doi: 10.3748/wjg.v25.i47.6799
Peer-review started: August 12, 2019
First decision: September 10, 2019
Revised: November 26, 2019
Accepted: November 29, 2019
Article in press: November 29, 2019
Published online: December 21, 2019
Liver transplantation (LT) remains the best option for patients with end-stage liver disease but the demand for organs from deceased donors continues to outweigh the available supply. The advent of highly effective anti-viral treatments has reduced the number of patients undergoing LT for hepatitis C (HCV) and hepatitis B (HBV) related liver disease and yet the number of patients waiting for LT continues to increase, driven by an increase in the patients listed with a diagnosis of cirrhosis due to non-alcoholic steatohepatitis and alcohol-related liver disease. In addition, human immunodeficiency virus (HIV) infection, which was previously a contra-indication for LT, is no longer a fatal disease due to the effectiveness of HIV therapy and patients with HIV and liver disease are now developing indications for LT. The rising demand for LT is projected to increase further in the future, thus driving the need to investigate potential means of expanding the pool of potential donors. One mechanism for doing so is utilizing organs from donors that previously would have been discarded or used only in exceptional circumstances such as HCV-positive, HBV-positive, and HIV-positive donors. The advent of highly effective anti-viral therapy has meant that these organs can now be used with excellent outcomes in HCV, HBV or HIV infected recipients and in some cases uninfected recipients.
Core tip: The optimal utilization of organs from hepatitis C (HCV), hepatitis B (HBV) and human immunodeficiency virus (HIV)-positive donors may help attenuate the current organ shortage. Transplantation of organs from patients with HCV viremia to uninfected recipients can be accomplished safely when coupled with the timely initiation of post-transplant direct-acting antiviral therapy. Suppression of HBV with antiviral therapy allows for the safe transplantation from HBV core antibody-positive donors to unexposed recipients, while transplantation of organs from patients who are HBV surface antigen-positive remains investigational. The early experience with HIV-to-HIV positive transplantation via the HOPE act is promising, and allows patients living with HIV improved access to transplantation.