The New Direct Antiviral Agents and Hepatitis C in Thoracic Transplantation: Impact on Donors and Recipients
AbstractPurpose of ReviewThe landscape of abdominal organ transplantation has been altered by the emergence of curative direct-acting antiviral agents for hepatitis C. Expansion of the thoracic donor pool to include the hearts and the lungs from hepatitis C-positive donors holds promise to increase available donor organs.Recent FindingsCase reports have documented separate lung and heart transplant patients who acquired, and then were cured of, donor-derived hepatitis C using these newer, more effective therapies. Single sites and national consortia are underway to help make this approach part of the standard-of-care. Pangenotypic therapies may simplify the paradigm.SummaryOrgans from donors with active hepatitis C viremia are likely suitable for transplant as long as the organ is otherwise acceptable. Best-practices for “informed-risk” transplant include a team-based approach and a selection of the antiviral regimen based on insurer’s formulary, potential drug interactions, and genotype.
National data demonstrate that increasing opportunities exist for organ donation among hepatitis C virus (HCV) infected individuals.
National data demonstrate that increasing opportunities exist for organ donation among hepatitis C virus (HCV) –infected individuals.
In conclusion, our data show how oncogenic and tumor-suppressive drivers of cellular senescence act to regulate surveillance processes that can be circumvented to enable SnCs to elude immune recognition but can be reversed by cell surface-targeted interventions to purge the SnCs that persist in vitro and in patients. Since eliminating SnCs can prevent tumor progression, delay the onset of degenerative diseases, and restore fitness; since NKG2D-Ls are not widely expressed in healthy human tissues and NKG2D-L shedding is an evasion mechanism also employed by tumor cells; and since increasing numbers of B cells express NKG2D ...
Previous studies suggest that direct-acting anti-virals (DAAs) for the treatment of hepatitis C virus (HCV) infection permits the transplantation of HCV-viremic donor organs in uninfected recipients. This opportunity may expand the donor pool. We assessed the impact of using HCV nucleic acid test –positive (NAT+) donor hearts on heart transplant (HTx) waitlist time and transplant rate.
Previous studies suggest that direct-acting antivirals (DAAs) for treatment of hepatitis C virus (HCV) infection permits transplantation of HCV-viremic donor organs in uninfected recipients. This opportunity may expand donor pool. We assessed the impact of utilizing HCV nucleic acid test-positive (NAT+) donor hearts on heart transplant (HTx) waitlist time and transplant rate.
The field of heart transplantation continues to evolve, with major changes in allocation systems, and increasing use of extended-criteria donor hearts, including hearts from donation after circulatory death (DCD) donors, hearts supported with ex-vivo perfusion, and hearts from hepatitis C viremic donors. Use of such non-traditional donor hearts has made transplantation available to a larger number of recipients, but the demand continues to outpace the supply. Given this persistent donor heart shortage, much attention has been given to the topic of donor-recipient size matching.
“It's not that we need new ideas, but we need to stop having old ideas.”Edwin H. Land (1909-1991, Cofounder of Polaroid Corporation)
“It's not that we need new ideas, but we need to stop having old ideas.”
Hepatitis C virus(HCV) donors should be categorized as HCV-viremic[Antibody(Ab) –or+/Nucleic Acid testing(NAT)+] or HCV Ab+ nonviremic(Ab+/NAT-). Whereas recipients of hearts from HCV-viremic donors will develop viremia but can likely be cured of HCV shortly after transplant with direct-acting antivirals (DAAs), recipients of hearts from HCV Ab+ nonviremic donors are highly u nlikely to become viremic or require DAAs. Given this important difference in risk, we assessed the utilization trends and post heart-transplantation(HT) outcomes of HCV-naïve (Ab-/NAT-), HCV-viremic and HCV Ab+ nonviremic donor hearts.
Discussion Transplantation is not a common problem for primary care physicians but when a child’s disease has progressed to end-stage organ failure, transplantation can be the only treatment available. While the primary care provider usually is not involved in the daily management of patients before, during and after transplantation, they can be involved in many areas. These can include providing appropriate primary and acute care, ordering and obtaining necessary medical tests, medications and equipment, assisting with medical insurance, providing medical history and records to consultants, translating medical infor...