Review of heart transplantation from hepatitis C-positive donors

Area of Science:

• Cardiology
• Hepatology
• Transplantation Immunology

Background:

• Increasing prevalence of end-stage heart failure and donor scarcity for heart transplantation (HT).
• Advancements in direct-acting antivirals (DAAs) offer effective treatment for hepatitis C virus (HCV) infection.
• Exploration of utilizing organs from HCV-positive donors to expand the donor pool.

Purpose of the Study:

• To review the current literature on heart transplantation using organs from HCV-positive donors.
• To evaluate the short-term outcomes and safety of HT from HCV-positive donors.
• To assess the impact of DAAs on HCV transmission and viral response in recipients.

Main Methods:

• Literature review of studies on heart transplantation from HCV-positive donors.
• Analysis of short-term outcomes including graft function, coronary artery vasculopathy, and associated organ diseases (kidney, liver).
• Evaluation of HCV transmission rates and sustained viral response (SVR) post-transplantation with DAA treatment.

Main Results:

• HT from HCV-positive donors is comparable to HCV-negative donors regarding short-term graft function and associated organ health.
• High incidence of donor-derived HCV transmission observed, but successfully managed with DAAs, achieving high SVR rates.
• Acceptance of HCV-positive organs led to a larger donor pool, younger donors, shorter wait times, and reduced waitlist mortality.

Conclusions:

• Utilizing HCV-positive donor hearts is a viable strategy to expand the donor pool for heart transplantation.
• DAAs are highly effective in treating HCV transmission in recipients, ensuring favorable short-term outcomes.
• Long-term outcomes and the influence of specific HCV genotypes require further investigation.