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Murine Cervical Heart Transplantation Model Using a Modified Cuff Technique
Published on: October 12, 2014
Utilization of Hepatitis C Virus-Infected Donor Hearts in Two Children and Two Young Adults: Initial Experience at a
Lauren E Kushner1, Lauren Puckett2, Joanne Lee2
1Division of Pediatric Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, California, USA.
Insights
Pediatric heart transplants using organs from hepatitis C virus (HCV)-positive donors are safe and effective. This approach expands the donor pool, offering better outcomes for children awaiting transplants.
Area of Science:
- Pediatric cardiology
- Organ transplantation
- Infectious diseases
Background:
- Adult transplant centers successfully use organs from hepatitis C virus (HCV)-infected donors (NAT+) for HCV-negative recipients.
- This practice is not widely adopted in the pediatric heart transplant community.
Observation:
- A pediatric transplant center performed heart transplants using organs from four HCV NAT+ donors.
- Two recipients were pediatric patients under 18 years old.
Findings:
- All recipients completed a 12-week glecaprevir/pibrentasvir treatment.
- Sustained virologic response was achieved with no HCV or liver complications.
- Good post-transplant outcomes were observed, including normal graft function and no rejection or vasculopathy.
Implications:
- This case series demonstrates the successful use of HCV NAT+ donor hearts in pediatric recipients.
- Utilizing these organs can expand the pediatric donor pool, reducing waitlist morbidity.
- Further research should explore using other organs and optimize antiviral therapy protocols.
Background:
Although adult transplant centers are successfully transplanting organs from hepatitis C virus (HCV)-infected donors with detectable viral load by nucleic acid testing (NAT+) into HCV-negative recipients, this practice has not yet been adopted widely by the pediatric heart transplant community.
Methods:
We present a case series of four patients who received heart transplants from HCV NAT+ donors at a pediatric transplant center, including two pediatric patients < 18 years of age.
Results:
All recipients tolerated a 12-week course of glecaprevir/pibrentasvir and achieved a sustained virologic response with no HCV or liver complications with over 1 year of follow-up (range 1.4-2.5 years). All four have had good post-heart transplant outcomes with normal graft function and good functional status without rejection or cardiac allograft vasculopathy at time of last follow-up.
Conclusions:
This case series details the successful multidisciplinary implementation of a protocol to accept cardiac allografts from HCV NAT+ donors for transplantation into HCV negative recipients at our pediatric transplant center. With the limited donor pool in pediatrics and the morbidity associated with prolonged durations on the transplant waitlist, pediatric centers should consider utilizing organs from HCV NAT+ donors to broaden the donor pool. Future work should evaluate other organs beyond heart and optimal timing and duration of direct acting antiviral therapy.
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