Bypassing the bottleneck: intentional hepatitis C transmission with organ transplant

Solid organ transplantation from hepatitis C virus–positive (HCV-positive) deceased donors into HCV-negative recipients is a recent approach aimed to expand the donor organ pool in the setting of severe shortage. Good short-term outcomes have been reported with this approach in combination with direct-acting antivirals. In this issue of the JCI, Zahid and colleagues have characterized early viral kinetics and the genetic landscape of donor-to-recipient HCV transmission using single-genome sequencing. In seven HCV-negative recipients of four HCV-positive donor organs, productive infection with a highly diverse viral population was seen by day three after transplantation. The degree of genetic diversity seen in recipients of HCV-positive organs was unlike the narrow genetic bottleneck typically observed with acute HCV acquisition from intravenous drug use or sexual activity. All recipients achieved HCV cure with treatment. The consequences of acute infection with a genetically diverse HCV population are unknown; however, early clinical experience with this transplantation strategy is promising.
Source: Journal of Clinical Investigation - Category: Biomedical Science Authors: Source Type: research

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CONCLUSIONS: Increased-risk donor organs provided high levels of utility in liver transplant recipients who were anti-HCV positive, showing optimal graft and patient survival. Increased-risk donors were younger and preferably transplanted in hepatitis C virus RNA-positive recipients with lower Model for End-Stage Liver Disease score. Posttransplant direct-acting antiviral therapy was highly efficacious irrespective of pretransplant recipient and donor virologic status. PMID: 31324136 [PubMed - as supplied by publisher]
Source: Experimental and Clinical Transplantation : official journal of the Middle East Society for Organ Transplantation - Category: Transplant Surgery Authors: Tags: Exp Clin Transplant Source Type: research
AbstractPurpose of reviewHepatitis C virus (HCV) infection is a principal cause of morbidity, mortality, and economic burden, and the global elimination of HCV is now considered a public health objective. Globally, an estimated 71 million have chronic HCV infection with an estimated annual mortality of 3,99,000.Recent findingsThe 69th World health Assembly has endorsed the global HCV elimination strategy by 2030, which is made possible because of all oral, cost-effective, efficacious, generic direct-acting antivirals. The public health strategy targets not only diagnosed chronic hepatitis C patients but also asymptomatic u...
Source: Current Treatment Options in Gastroenterology - Category: Gastroenterology Source Type: research
ConclusionsProlonged use of cyclosporine may expose to several dose-related adverse events and may contribute to the development of allograft dysfunction but it does not necessarily cause relentless, progressive transplant failure if patients are carefully and consistently monitored during the follow-up.
Source: Clinical and Experimental Nephrology - Category: Urology & Nephrology Source Type: research
ConclusionsRates of ODD utilization in lung transplantation have increased in accordance with the opioid epidemic, but there remains a significant pool of ODD pulmonary allografts with favorable characteristics that are discarded. With no significant difference in survival between ODD and non-ODD recipients, further expansion of this donor pool may be appropriate and pulmonary allografts should not be discarded based solely on ODD status.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
Of the 28 million population of Punjab (2011 Census), 3.6% are estimated to be positive for anti HCV antibody and 2.6% (728,000) are estimated to test positive for HCV RNA.[1,2] A majority of these people may progress to cirrhosis and its complications including variceal bleeding, liver failure and hepatocellular carcinoma (HCC), or death.[3,4] Successful treatment of chronic hepatitis C (CHC) is associated with 62-84% reduction in all-cause mortality, 68-79% reduction in risk of HCC and 90% reduction in need for liver transplantation.
Source: Journal of Hepatology - Category: Gastroenterology Authors: Source Type: research
CONCLUSIONS: Rates of ODD utilization in lung transplantation have increased in accordance with the opioid epidemic, but there remains a significant pool of ODD pulmonary allografts with favorable characteristics that are discarded. With no significant difference in survival between ODD and non-ODD recipients, further expansion of this donor pool may be appropriate and pulmonary allografts should not be discarded based solely on ODD status. PMID: 31323210 [PubMed - as supplied by publisher]
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Ann Thorac Surg Source Type: research
Conditions:   Lung Transplant Infection;   Heart Transplant Infection;   Kidney Transplant Infection;   Kidney Pancreas Infection;   Hepatitis C Interventions:   Drug: Glecaprevir 300 MG / Pibrentasvir 120 MG Oral Tablet;   Drug: Ezetimibe 10Mg Oral Tablet;   Device: Ex Vivo Lung Perfusion Sponsors:   Jordan Feld;   University Health Network, Toronto Recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
ConclusionIn 2016, NASH surpassed HCV as the leading indication for WL registration among the 1945-1965 birth cohort. Improved HCV screening, increased availability of effective HCV treatment, and rising prevalence of NAFLD may explain changes in LT indication among this group.
Source: Journal of Clinical and Experimental Hepatology - Category: Gastroenterology Source Type: research
Abstract PURPOSE OF REVIEW: This review is a brief overview of current guidelines on screening donors and candidates for bacterial, fungal, parasitic and viral infections prior to solid organ transplantation. The pretransplant period is an important time to evaluate infection exposure risk based on social history as well as to offer vaccinations. RECENT FINDINGS: One of the major changes in the past few years has been increased utilization of increased Public Health Service risk, HIV positive, and hepatitis C-positive donors. There has also been increased attention to donor and recipient risks for geographica...
Source: Current Opinion in Organ Transplantation - Category: Transplant Surgery Authors: Tags: Curr Opin Organ Transplant Source Type: research
Purpose of review This review is a brief overview of current guidelines on screening donors and candidates for bacterial, fungal, parasitic and viral infections prior to solid organ transplantation. The pretransplant period is an important time to evaluate infection exposure risk based on social history as well as to offer vaccinations. Recent findings One of the major changes in the past few years has been increased utilization of increased Public Health Service risk, HIV positive, and hepatitis C-positive donors. There has also been increased attention to donor and recipient risks for geographically associated infec...
Source: Current Opinion in Organ Transplantation - Category: Surgery Tags: INFECTIOUS DISEASES: Edited by Emily Blodget Source Type: research
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