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Hepatitis C donor viremic cardiac transplantation: A practical approach
Kathleen L Morris1, James P Adlam1, Mathew Padanilam1
1Department of Cardiology and Advanced Heart Failure and Cardiac Transplantation, PSC. St. Vincent Hospital, Indianapolis, Indiana.
Insights
Using hepatitis C virus (HCV) positive donor hearts for transplantation is safe and effective. This approach increases organ availability without impacting short-term outcomes for heart transplant recipients.
Area of Science:
- Transplantation Medicine
- Infectious Diseases
- Cardiology
Background:
- Orthotopic heart transplantation (OHT) is limited by donor organ scarcity.
- Highly effective direct-acting antiviral (DAA) therapies for hepatitis C virus (HCV) have become available.
- HCV-viremic donor organs are increasingly considered for transplantation.
Purpose of the Study:
- To evaluate the safety and efficacy of using HCV-viremic donor hearts for OHT.
- To compare outcomes of OHT recipients receiving HCV+ organs versus those receiving HCV-negative organs.
Main Methods:
- Retrospective review of patients undergoing OHT.
- Analysis of baseline demographics, laboratory data, and clinical outcomes.
- Focus on recipients of HCV-viremic donor hearts compared to non-HCV recipients.
Main Results:
- 23 of 25 HCV recipients received organs from NAT+ donors, with rapid seroconversion observed.
- No significant differences in rejection rates, hospitalizations, or mortality were found between HCV+ and non-HCV transplant groups.
- HCV treatment was completed by 15 recipients, with a maximum follow-up of 13 months.
Conclusions:
- Utilizing HCV-viremic donor hearts expands the donor pool for OHT.
- HCV treatment in immunosuppressed transplant recipients is well-tolerated and achieves sustained virologic response.
- Viremic HCV OHT can be safely performed with a multidisciplinary approach, showing no adverse short-term effects.
Introduction:
Patients with end-stage heart failure eligible for orthotopic heart transplantation (OHT) exceed the number of available donor organs. With highly effective hepatitis C virus (HCV) antiviral therapy now available, HCV+ organs are increasingly utilized. We seek to describe our experience with patients receiving HCV viremic organs as compared to non-HCV transplant recipients.
Methods:
Our center began utilizing HCV hearts in February 2018. We retrospectively reviewed baseline demographics, laboratory data and outcomes for those undergoing OHT with majority being from a viremic HCV donor.
Results:
Twenty-three of 25 HCV recipients received hearts from NAT+ donors with 22 of 23 seroconverting within 7 days. Fifteen recipients have completed HCV treatment, with the longest duration of follow-up being 13 months. No differences in rates of rejection, hospitalizations or death were seen between non-HCV and HCV transplant patients.
Discussion:
With the advent of available direct-acting antivirals (DAAs), viremic HCV hearts provide an opportunity to increase organ availability. Moreover, treatment for HCV in the setting of immunosuppression is well-tolerated and results in sustained viremic response.
Conclusion:
Viremic, discordant HCV OHT can be performed in a safe and effective manner utilizing a systematic, multidisciplinary approach without an effect on short-term outcomes.
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