Trends in candidate HCV NAT+ listing and associated impacts on liver transplantation waitlist outcomes

Study Overview

Organ shortages continue to limit access to lifesaving liver transplants. With the advent of highly effective direct-acting antivirals, hepatitis C virus (HCV)-positive donor organs have become a safe and valuable resource. Using registry data from the United Network for Organ Sharing (UNOS) for adult waitlist registrations between 2016 and 2023, Dr. Salinas Parra explored how candidates’ consent to receive HCV nucleic acid amplification test–positive (HCV NAT+) livers has evolved, and whether agreeing to HCV NAT+ listing at initial registration affects time to transplant and waitlist survival.

Key Findings

• The rate of initial HCV NAT+ listing rose sharply from 8.8% in 2016 to 60.8% in 2023, reflecting growing confidence in HCV+ graft safety.
• Despite overall growth, women, Hispanic, and Asian candidates remained significantly less likely to consent to HCV NAT+ organs.
• Geographic uptake varied, with the Midwest achieving the highest listing rates by 2023.
• Initial consent to HCV NAT+ listing was linked to a 17% lower hazard of waitlist mortality (HR 0.83; 95% CI 0.78–0.89).

Clinical Significance

These findings highlight that while broad adoption of HCV NAT+ listing can improve transplant access and survival, persistent demographic and regional gaps undermine equity. Implementing standardized, culturally sensitive education and consent processes is essential to ensure all patients benefit equally from this advance.