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Hepatitis C transmission and infection by orthotopic heart transplantation
1Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104-4283, USA.
Insights
Hepatitis C virus (HCV) transmission is likely from infected donors to heart transplant recipients. HCV RNA detection is crucial, as antibodies may be negative for over a year post-transplant.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Immunology
Background:
- Orthotopic heart transplantation (OHT) from hepatitis C virus (HCV)-infected donors to HCV-naive recipients is not well-documented.
- This study investigates the outcomes of 5 such OHT cases within a one-year period.
Purpose of the Study:
- To describe the transmission and clinical consequences of HCV infection acquired during OHT.
- To evaluate the diagnostic utility of HCV RNA and antibody testing post-transplant.
Main Methods:
- Retrospective analysis of 5 HCV-naive recipients of OHT from HCV-positive donors.
- Monitoring of clinical course, liver enzymes, HCV antibodies, HCV RNA, and HCV genotype post-transplantation.
Main Results:
- HCV transmission occurred in 4 out of 5 recipients, confirmed by HCV RNA.
- Liver enzymes peaked early post-transplant but normalized within 6-12 months.
- Only 1 of 5 patients developed HCV antibodies after 15 months, highlighting delayed seroconversion.
Conclusions:
- HCV transmission via OHT from infected donors to naive recipients is probable.
- HCV RNA testing is essential for early diagnosis due to potential for negative antibody tests.
- Limiting HCV-positive donor hearts to critically ill patients is recommended pending further long-term outcome data.
Background:
The transmission and clinical consequences of hepatitis C viral (HCV) infection acquired by orthotopic heart transplantation (OHT) from an HCV-infected donor to an HCV-naive recipient have not been well described. We report our experience in 5 HCV-naive patients who were transplanted with hearts from HCV-positive donors. All transplants occurred within a 1-year period.
Methods:
After cardiac transplantation we retrospectively examined the recipients' clinical course, liver-associated enzymes, HCV-antibody serology, quantitative HCV RNA level, and HCV genotype.
Results:
Five subjects with rapidly deteriorating heart failure and negative serum antibodies to HCV received an emergent OHT from a donor known to be infected with HCV. Liver-associated enzymes peaked at 2 to 6 weeks post-transplant: mean peak alanine aminotransferase was 180 U/L (normal, 9 to 52) and aspartate aminotransferase was 111 U/L (normal, 14 to 36). Liver enzymes had returned to normal limits by 6 and 12 months post-OHT. At a mean 15 months after transplantation, only 1 of 5 patients has developed antibodies to HCV, but 4 of 5 have evidence of infection, as shown by serum HCV RNA. No patient has developed evidence of liver failure.
Conclusions:
(1) Transmission of HCV from an HCV-positive donor to an HCV-naive recipient at the time of OHT is likely. (2) Antibodies to HCV post-OHT may remain negative for more than 1 year in these patients. (3) Hepatitis C viral RNA using polymerase chain reaction should be the test of choice for diagnosis of HCV infection post-OHT. (4) Hepatitis C viral donor hearts should be limited to critically ill patients in extremis until the long-term consequences of acquisition of HCV by an OHT recipient are known.