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Approaches and strategies to manage the hepatitis C virus-positive heart donor
Brent C Lampert1, Kevin Kissling2
1Division of Cardiovascular Medicine.
Insights
Using hepatitis C virus (HCV)-positive donors expands heart transplant availability. Prophylactic antiviral therapy shows promising short-term outcomes, suggesting it as the current standard of care for these patients.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Immunology
Background:
- Cardiac transplantation is limited by donor organ shortage.
- Hepatitis C virus (HCV)-positive donors are increasingly utilized to expand the donor pool.
- Advanced heart failure necessitates innovative solutions for transplantation access.
Purpose of the Study:
- To review the history and outcomes of HCV-positive donor heart transplantation.
- To evaluate modern antiviral drug therapy in recipients of HCV-positive hearts.
- To assess the safety and efficacy of utilizing HCV-positive donors for cardiac transplantation.
Main Methods:
- Review of single-center studies and retrospective data on HCV-positive donor heart transplantation.
- Analysis of outcomes associated with direct-acting antiviral (DAA) therapy.
- Comparison of prophylactic versus preemptive DAA treatment strategies.
Main Results:
- HCV-positive donor hearts have demonstrated good short-term outcomes and reduced waitlist times.
- DAA therapy has shown efficacy in clearing viremia in recipients.
- Prophylactic DAA administration appears safe and effective in the early post-transplant period.
Conclusions:
- Utilization of HCV-positive donors expands the heart donor pool and is safe in the early post-transplant phase.
- Prophylactic administration of a pangenotypic DAA agent should be considered the standard of care.
- Further research is needed on medium- and long-term outcomes and optimal DAA treatment strategies.
Purpose Of Review:
Cardiac transplantation remains the treatment of choice for patients with advanced heart failure, but is limited by a donor organ shortage. Utilization of hepatitis C virus (HCV)-positive donors has been recently adopted to expand access to heart transplantation. We review the history of HCV heart transplantation, modern drug therapy, and recent outcomes.
Recent Findings:
Since the advent of direct-acting antiviral (DAA) therapy, several single-center studies, and retrospective reviews have demonstrated good short-term outcomes, shorter waitlist times, and clearance of viremia with recipients of HCV-positive hearts. Two principle approaches to treatment of recipients of HCV viremic donors are utilized. In the prophylactic strategy, therapy is initiated before viremia is detected compared with the preemptive approach where initiation of DAA is delayed until after viremia is detected. Future studies are needed to address uncertainty about medium and long-term outcomes of using HCV-positive hearts and to determine the optimal treatment timing and duration.
Summary:
Utilization of HCV-positive donors has expanded the heart donor pool and appears safe through the early posttransplant period. We suggest that prophylactic administration of the shortest effective course of a DAA pangenotypic agent should be the current standard of care.
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