Hepatitis C-infected Heart and Lung Transplants Safe Hepatitis C-infected Heart and Lung Transplants Safe
Organs donated from people infected with hepatitis C can be safely transplanted, and any transmission of the virus can be treated with antiretrovirals, new research shows.Medscape Medical News
Hepatitis C (HCV) donors are rarely used for cardiac transplantation due to historically poor outcomes. In 2015, nucleic acid testing (NAT) for viral load was added to the routine work-up of organ donors, allowing for the distinction between subjects who remain viremic (HCV Ab+/NAT+) and those who have cleared HCV and are no longer viremic (HCV Ab+/NAT –). The American Society of Transplantation recently recommended that HCV Ab+/NAT– donors be considered non-infectious and safe for transplantation.
Conclusion: In the United States, transplantation with ODD organs has increased dramatically, with noninferior outcomes in transplant recipients. Concerns about IRD behaviors and hepatitis C among donors lead to excess discard that should be minimized given the current organ shortage. Primary Funding Source: National Institutes of Health. PMID: 29710288 [PubMed - as supplied by publisher]
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. Pang...
There is growing use of increased risk donor organs that convey a higher risk of donor transmission of Hepatitis B, Hepatitis C, and HIV. Currently, Hepatitis B (HepB) is the only one of these three that is preventable through vaccination. We previously reported that immunity to HepB among lung transplant candidates at time of evaluation was only 23%, despite report of prior HepB vaccination in some cases. Although vaccine response rates among young, healthy individuals are approach 90%, rates among immunocompromised individuals are as low as 39%.
Considering the success of direct-acting antivirals (DAAs) to treat hepatitis C (HCV) and the shortage of organs for heart transplantation (HT), we institutionalized clinical protocol of using HCV-exposed donors in selected waitlist candidates. Prior to advent of DAAs, donor HCV viremia predicted poor post-HT outcomes, including higher risk of coronary allograft vasculopathy (CAV). Using intracoronary ultrasound (ICUS) in patients acquiring post-HT HCV infection, we examined the risk of CAV in current era.
Historically, potential lung donors who have detectable antibodies to Hepatitis C virus have been declined by most centers due to concern for possibility of disease transmission. Improvements in the sensitivity of Nucleic Antigen Testing (NAT) has resulted in a smaller “window” period of 3-5 days, in which virus may be present and transmissible but not detectable in the serum, lessening the risks associated with using such donors. We sought to evaluate hepatitis C viral transmission rates from donors who were known to be HCV Ab positive but HCV NAT negative.
There is a large gap in the number of people waiting for heart transplant compared with the number of available donors. Despite an increase in heart transplants performed, only 25-30% of offered donor hearts are utilized. Simultaneously the number of drug overdoses in the United States resulting in death is increasing, with a quarter of these testing positive for Hepatitis C. Due to recent breakthroughs in the treatment of Hepatitis C, it is now curable. The safety and efficacy of treatment allows us to explore the use of Hepatitis C positive organs for transplant.
We describe our center ’s experience with heart and combined heart-kidney transplantation from HCV-infected donors to uninfected recipients.
Given the need for thoracic organs and the high mortality of patients awaiting heart or lung transplantation, it is imperative to find ways to increase the donor pool. An approach that can immediately and substantially increase organ availability is to safely utilize thoracic organs from donors infected with hepatitis C virus (HCV). With the advent of direct acting antivirals (DAA) and recent advances in HCV treatment, we designed and implemented a clinical trial to assess the safety and efficacy of transplanting thoracic organs from HCV positive donors into HCV uninfected recipients.
We report a case of heart-kidney transplantation from an HCV (+) donor to (-) recipient with subsequent infection and clearance with anti-viral therapy.