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Practices of cardiothoracic transplant centers regarding hepatitis C-seropositive candidates and donors
S K Milfred1, K D Lake, D J Anderson
1Division of Cardiothoracic Transplantation and Research, Minneapolis Heart Institute, Minnesota.
Insights
Most cardiothoracic transplant centers accept hepatitis C (HCV)-seropositive candidates and organs from HCV-seropositive donors. Practices vary, highlighting the need for further research on HCV infection in transplant patients.
Area of Science:
- Transplant Surgery
- Hepatology
- Infectious Diseases
Background:
- Hepatitis C virus (HCV) infection poses challenges in organ transplantation.
- Current literature lacks comprehensive data on HCV's impact on transplant outcomes.
Purpose of the Study:
- To assess current practices of cardiothoracic transplant centers regarding HCV-seropositive candidates and donors.
- To identify the methodologies used for HCV screening in transplant programs.
Main Methods:
- A telephone survey was conducted in October 1992 with 48 cardiothoracic transplant centers.
- The survey queried policies on listing HCV-seropositive candidates and accepting organs from HCV-seropositive donors.
- Information on HCV assay methodologies was also collected.
Main Results:
- 75% of responding centers accept HCV-seropositive candidates, while 16% do not.
- 69% of centers accept organs from HCV-seropositive donors, with variations based on recipient status.
- Second-generation ELISA/EIA tests are commonly used for HCV screening, often followed by confirmatory assays or liver biopsy.
Conclusions:
- Significant variation exists in transplant center practices concerning HCV-seropositive individuals.
- Existing data do not indicate a substantial increase in morbidity or mortality due to HCV in transplant recipients.
- Prospective, controlled trials are essential to fully evaluate HCV's impact in cardiothoracic transplantation.
Abstract:
The purpose of this survey was to determine current practices of cardiothoracic transplant centers regarding transplantation of hearts and lungs into hepatitis C (HCV)-seropositive candidates and the use of organs from HCV-seropositive donors. A telephone survey of 48 cardiothoracic transplant centers was conducted in October 1992. Questions included the center's policy for listing HCV-seropositive candidates; if, and under what conditions, organs from HCV-seropositive donors would be used; and which HCV assays were used. Forty-five programs responded; 75% will list an HCV-seropositive candidate, either directly or by lack of routine screening to exclude such patients; only 16% will not accept HCV-seropositive candidates; 9% had no policy. Overall, 69% will accept organs from HCV-seropositive donors, at least for selected recipients (22% for any recipient, 45% for HCV-seropositive and/or status I recipients; 2% do not screen donors). A total of 27% will never accept organs from an HCV-seropositive donor, and 4% had no policy. Thirty centers provided information on HCV methodology. All but one use a second generation ELISA or EIA as a first-line test. A positive result will be followed by a confirmatory assay/liver biopsy in 42%. The variation in practices reflects the ambiguity in the literature. Adequate evaluation of morbidity and mortality due to HCV infection in this population has not yet been possible, although currently available reports do not show a substantial increase. Prospective controlled trials in cardiothoracic transplant patients are necessary.