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Updated: Jul 15, 2026
Murine Heterotopic Heart Transplant Technique
Published on: July 8, 2014
Successful Treatment of Chronic Hepatitis C Infection With Direct-Acting Antivirals in a Heart Transplant Recipient:
1Department of Transplantation, Temple University Hospital, Philadelphia, Pennsylvania.
Insights
Direct-acting antivirals (DAA) offer a safe and effective treatment for hepatitis C virus (HCV) infection in heart transplant recipients. This approach achieved sustained virologic response without impacting graft function or cardiac stability.
Area of Science:
- Hepatology
- Transplant Surgery
- Infectious Diseases
Background:
- Heart transplant (HT) recipients with chronic hepatitis C virus (HCV) infection face increased morbidity and mortality.
- Previous HCV treatments had low cure rates and significant risks, including graft rejection and side effects.
Observation:
- A heart transplant recipient with chronic HCV infection was monitored post-transplant.
- Interferon-based therapy was contraindicated due to risks of graft failure and cardiac decompensation.
- Worsening liver fibrosis prompted treatment with direct-acting antivirals (DAA).
Findings:
- The patient received a 12-week course of sofosbuvir and simeprevir.
- Treatment was well-tolerated, with stable cardiac status and no tacrolimus dose adjustments.
- Rapid virologic response and sustained virologic response at 12 weeks were achieved.
- Biochemical improvements in liver and renal function were observed.
Implications:
- Direct-acting antivirals (DAA) represent a safe and effective option for managing HCV in heart transplant recipients.
- Successful HCV treatment can improve outcomes in this vulnerable patient population.
- DAA therapy may be considered in HT recipients with progressive liver disease.
Background:
Heart transplant (HT) recipients with chronic hepatitis C virus (HCV) infection are noted to have higher rates of HCV related morbidity and mortality. Treatment of HCV in the past was fraught with low cure rates, increased risk of graft rejection, and medication-related side effects.
Case Report:
We report a case of successful treatment of HCV infection in a HT recipient. The patient was found to have HCV during his pretransplant workup. He underwent uneventful orthotopic HT in 2000. The HCV infection was monitored with regular liver enzymes and the surveillance liver biopsies at 2 and 5 years after HT showed mild but stable liver disease, and he stayed on chronic immunosuppression. He was not offered interferon-based HCV therapy because of the risk of steroid-resistant graft failure and cardiac decompensation. With the availability of the new direct-acting antivirals (DAA) for HCV infection, and worsening of liver fibrosis on noninvasive testing, we treated him with sofosbuvir and simeprevir for 12 weeks. During treatment, he remained clinically stable from a cardiac standpoint and he showed biochemical improvement in his liver and renal functions. Tacrolimus levels remained stable and did not require any dose adjustment. He showed rapid virologic response and subsequently achieved sustained virologic response at 12 weeks.
Conclusion:
DAA use was safe and effective in treating HCV infection in a HT recipient.
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