High multiplicity of infection following transplantation of hepatitis C virus–positive organs

Highly effective direct-acting antivirals against hepatitis C virus (HCV) have created an opportunity to transplant organs from HCV-positive individuals into HCV-negative recipients, since de novo infection can be routinely cured. As this procedure is performed more widely, it becomes increasingly important to understand the biological underpinnings of virus transmission, especially the multiplicity of infection. Here, we used single genome sequencing of plasma virus in 4 genotype 1a HCV-positive organ donors and their 7 organ recipients to assess the genetic bottleneck associated with HCV transmission following renal and cardiac transplantation. In all recipients, de novo infection was established by multiple genetically distinct viruses that reflect the full phylogenetic spectrum of replication-competent virus circulating in donor plasma. This was true in renal and cardiac transplantation and in recipients with peak viral loads ranging between 2.9–6.6 log10 IU/mL. The permissive transmission process characterized here contrasts sharply with sexual or injection-related transmission, which occurs less frequently per exposure and is generally associated with a stringent genetic bottleneck. These findings highlight the effectiveness of current anti-HCV regimens while raising caution regarding the substantially higher multiplicity of infection seen in organ transplantation–associated HCV acquisition.
Source: Journal of Clinical Investigation - Category: Biomedical Science Authors: Source Type: research

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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
Conclusion At liver transplant centers in Germany DAA before LT is attempted in the majority of cases. It appears to be associated with an improved outcome and seems safe at least in individuals with MELD below or equal to 20.
Source: European Journal of Gastroenterology and Hepatology - Category: Gastroenterology Tags: Original Articles: Hepatology Source Type: research
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