A Concise Review of Hepatitis C in Heart and Lung Transplantation

Abstract

Hepatitis C (HCV) infection is prevalent in recipients of, and candidates for, solid organ transplants. The outcomes of HCV infection in cardiac and lung transplant recipients have yet to be clearly established, and future prospective studies are needed. In the absence of safe and effective antiviral treatment for HCV infection in heart and lung transplant recipients, the management of these patients remains a challenge and must be considered on an individual basis. Interferon therapy for HCV before transplantation appears to improve outcomes; however, post-transplant interferon therapy in the cardiac and pulmonary transplant setting may be associated with an increased risk of graft rejection. Given the paucity of information regarding HCV treatment in these transplant recipients, and with appropriate concerns that graft loss from rejection may not be amenable to a second transplant (given the scarcity of suitable cadaveric organs), multicentre, randomized controlled trials are needed to determine the optimal approach for treatment of HCV infection in this population.

Hepato-cardiac disorders

“…Higher MELD scores predict higher postoperative complication rates, including reoperation for bleeding, bacterial infections, and inhospital death [124] . Patients with chronic hepatitis C or chronic hepatitis B should be treated before HTx to avoid antiviral drug intake after HTx which may be associated with graft rejection [125] . Finally, patients with heart failure and irreversible cirrhosis could be offered combined heart and liver transplantation [126] .…”

Challenges in Long-Term Mechanical Circulatory Support and Biological Replacement of the Failing Heart

“…Furthermore, prospective studies are needed to clarify the influence of HCV seropositivity (present before transplant or acquired with/after transplant) on outcomes, and multicenter, randomized controlled trials are needed to establish optimal pre-and post-transplant approaches to treatment of HCV infection. 53 …”

Who needs a transplant and when?

“…Small studies have suggested that hepatitis C (HCV) patients have comparable after heart transplantation survival to patients without HCV [72,73]. However, in the absence of well tolerated and effective antiviral treatment for HCV in heart transplantation patients, decisions regarding candidacy should be individualized based on synthetic liver function, absence of cirrhosis, portal hypertension and degree of active viral replication.…”