The impact of utilizing hepatitis c virus nucleic acid test-positive donor hearts on heart transplant 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.
In recent years, emerging data has demonstrated that organs from Hepatitis C Virus (HCV)-infected donors can be transplanted into uninfected recipients with excellent outcomes. Critical to this success is the use of pre-emptive or prophylactic direct-acting antiviral (DAA) therapy, with the intent to minimize any viral transmission and block viral replication. The optimal timing to employ such therapy, whether at the time of transplant or following the detection of viremia, remains a matter of ongoing debate.
“Expand the donor pool” has been the mantra of the transplant community for decades. In recent years, Hepatitis C donor heart use and technology that supports donation after circulatory death have created new avenues to increase donors. (1,2). However, the acceptance rate of potential heart dono rs continues to be low at 29%, driven down by stringent criteria like left ventricular systolic dysfunction (LVSD)(3,4). Brain death itself leads to LVSD in nearly 50% of potential donors (5). The inflammatory cascade of brain death, mediated by catecholamine surge and rapid depletion of cortisol, a nti-diuretic hormone...
Heart transplantation continues to be limited by a paucity of donor organs despite innovations in organ procurement and organ preservation, greater willingness to accept marginal hearts (such as those from older donors with medical comorbidities such as diabetes and hypertension, left ventricular hypertrophy, and left ventricular dysfunction) and use of hearts from donors who died of drug overdose, donors with hepatitis C viremia and donors after circulatory death.(1, 2) These developments have expanded the donor pool and have changed perceptions and practices with respect to consideration of heart transplant donors.
Increased utilization of hepatitis C virus (HCV)-positive donors has increased transplantation rates. However, high levels of viremia have been documented in recipients of viremic donors. There is a knowledge gap in how transient viremia may impact acute cellular rejections (ACRs).
: Increased utilization of hepatitis C positive (HCV) donors has increased transplantation rates. However, high levels of viremia have been documented in recipients of viremic donors. There is a knowledge gap in how transient viremia may impact acute cellular rejections.
Thoracic organs from Hepatitis C virus (HCV) positive donors are not commonly used for transplantation. The development of direct-acting antivirals (DAA) for HCV treatment has led to renewed interest in using HCV-positive organs. We evaluated HCV transmission rates, viremia clearance, and short-term outcomes in HCV-negative patients who received HCV-positive thoracic organs at our institution. From January 1, 2018 to May 31, 2019, 38 patients underwent HCV-positive thoracic organ transplantation (16 lungs and 22 hearts).
The continued shortage of donor organs, together with a sustained increase in the number of potential donors with hepatitis C virus (HCV) infection (related to the ongoing opioid epidemic) and the advent of direct acting antiviral agents(DAA), has led to increased utilization of HCV-positive donors for heart transplantation(HT) (1). Furthermore, multiple recent studies have shown that 1-year HT-survival using HCV-positive donors in the current era of DAAs is similar to HT-survival using non-HCV donors (1,2).
The continued shortage of donor organs, together with a sustained increase in the number of potential donors with hepatitis C virus (HCV) infection (related to the ongoing opioid epidemic) and the advent of direct-acting anti-viral agents (DAAs), has led to increased utilization of HCV-positive donors for heart transplantation (HT).1 Furthermore, multiple recent studies have shown that 1-year HT survival using HCV-positive donors in the current era of DAAs is similar to the HT survival using non-HCV donors.
CONCLUSION: Within a solid organ transplantation program, clinical pharmacists and other pharmacy personnel can play vital roles in ensuring safe and effective DAA therapy for recipients of transplanted HCV NAT-positive organs. PMID: 32537658 [PubMed - as supplied by publisher]
Organ transplantation is undergoing profound changes. Contraindications for donation have been revised in order to better meet the organ demand. The use of lower-quality organs and organs with greater preoperative damage, including those from donation after cardiac death (DCD), has become an established routine but increases the risk of graft malfunction. This risk is further aggravated by ischemia and reperfusion injury (IRI) in the process of transplantation. These circumstances demand a preservation technology that ameliorates IRI and allows for assessment of viability and function prior to transplantation. Oxygenated h...