Hepatitis C Positive Organ Donation in Heart Transplantation

Siddiqi, Hasan K.; Schlendorf, Kelly

doi:10.1007/s40472-021-00350-1

Cited by 12 publications

(10 citation statements)

References 36 publications

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“…Although previous studies have reported comparable early or mid‐term outcomes of HCV+ donors in HT, our study provides unique insights into the subset of patients with concomitant liver disaese 12–14 . Prior to introduction of DAA treatment in 2014, use of HCV donor hearts was associated with negative outcomes in HT 15 represented a 1.5 to 3‐fold greater risk of mortality and 2.8‐fold risk of allograft vasculopathy 3,16 . Following successful utilization of HCV NAT+ donor hearts with HCV treatment after HT, mortality after HT using HCV+ donor hearts was dramatically decreased 17 .…”

Section: Discussionmentioning

confidence: 74%

“…Other variables were similar among the two groups. The median days on waitlist was comparable between the two groups (HCV+, 61 [15,246] days vs. HCV-neg, 64 [12,238] days, p = .44)…”

Section: Recipient Characteristicsmentioning

confidence: 89%

“…17 Currently, DAA treatment can be administered either after confirmation of donor-transmitted HCV or prophylactically before transplantation. 15 Despite its high cure rate and favorable mid-term results of HT using HCV+ hearts, longer-term outcomes remain unclear, especially in recipients with compromised liver function. The New York University group reported a higher incidence of acute cellular rejection in HCV+ donor during the period of seroconversion to HCV+ and active viremia.…”

Section: Discussionmentioning

confidence: 99%

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Utilization of hepatitis C virus infected donors in heart transplant recipients with elevated MELD‐XI score

Hirani,

Okumura,

Isath

et al. 2023

Clinical Transplantation

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BackgroundThe advent of direct‐acting antivirals has helped to increase the safe utilization of organs from hepatitis C virus positive (HCV+) donors. However, the outcomes of heart transplantation (HT) using an HCV+ donor are unclear in recipients with underlying liver disease represented by an elevated model for end‐stage liver disease excluding international normalized ratio (MELD‐XI).MethodsThe United Network of Organ Sharing database was queried from Jan 2016 to Dec 2021. Post‐transplant outcomes stratified by recipient MELD‐XI score (low <10.37, medium, 10.38–13.39, and high >13.4) was compared between patients with HT from HCV+ (N = 792) and patients with HT from HCV‐negative donors (N = 15,266).ResultsThe median MELD‐XI score was comparable (HCV+, 12.1, vs. HCV‐negative, 11.8, p = .37). In the HCV+ group, donors were older (33 vs. 31 years, p < .001). Ischemic time of donor hearts (3.48 vs. 3.28 h, p < .001) and travel distance (250 vs. 157 miles, p < .001) were longer in HCV+ group. In the Kaplan Meier analysis with a median follow‐up of 750 days, survival was comparable between the two groups (2‐year survival, MELD‐XI Low: HCV+, 92.4 ± 3.6% vs. HCV‐negative, 91.1 ±.8%, p = .83, Medium: HCV+ 89.2 ± 4.3% vs. HCV‐negative, 88.2 ± 1.0%, p = .68, and High: HCV+, 84.9 ± 4.5% vs. HCV‐negative, 84.6 ± 1.1%, p = .75) In multivariate Cox hazard models, HCV donors were not associated with mortality in each MELD‐XI subgroup (Low: adjusted hazard ratio (aHR), 1.02, p = .94; Medium: aHR, .95, p = .81; and High: aHR, .93, p = .68).ConclusionUtilization of HCV+ hearts was not associated with an increased risk of adverse outcomes in recipients with an elevated MELD‐ XI score.

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Section: Discussionmentioning

confidence: 74%

“…Other variables were similar among the two groups. The median days on waitlist was comparable between the two groups (HCV+, 61 [15,246] days vs. HCV-neg, 64 [12,238] days, p = .44)…”

Section: Recipient Characteristicsmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Utilization of hepatitis C virus infected donors in heart transplant recipients with elevated MELD‐XI score

Hirani,

Okumura,

Isath

et al. 2023

Clinical Transplantation

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“…The use of hepatitis C-infected hearts has rapidly expanded in recent years with the availability of direct acting antiretroviral drugs with high sustained virological response (cure) rates. [17][18][19] Usage of these hearts is still not universal with remaining concerns regarding rejection, 20,21 allograft vasculopathy, 22 cost of the antiviral agents, 23 and limited center experience preventing widespread adoption. 24,25 Additional experience over time will provide reassurance of the safety of these organs, despite the additional complexity of intentional recipient infection with hepatitis C.…”

Section: Discussionmentioning

confidence: 99%

Donor Utilization in the Recent Era: Effect of Sex, Drugs, and Increased Risk

Baran

Long

Lansinger

et al. 2022

Circ: Heart Failure

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Background: Heart transplantation volumes have increased in recent years, yet less than a third of donors are typically accepted for transplantation. Whether donor sex, donor drug use, or perception of increased risk affects utilization for transplantation is unclear. Methods: The United Network for Organ Sharing database was queried for donors from January 1, 2007, to December 31, 2017. Donor toxicology was collected when available. Multivariate analysis was conducted to examine correlations with donor utilization. Results: Between January 1, 2007, and December 31, 2017, there were 87 816 heart donors aged ≥15 years. The mean age was 42.7±15.8 years, and 24 831 donors (28.3%) were utilized for heart transplantation. Subsequent analyses focused on donors between 15 and 39 years old. The strongest associations with donor acceptance were for male donor sex, blood type, hepatitis C antibody, donor age, left ventricular hypertrophy, and history of donor drug use. After removing hepatitis C, Public Health Service Increased Risk was identified as a strong negative predictor. Most positive drug toxicology results were associated with donor nonuse except for donors between 15 and 19 years of age. Exceptions included alcohol, marijuana, and cocaine. Opiates were associated with less utilization at all donor ages. The Public Health Service Increased Risk status was associated with significantly less utilization in all age groups except 15- to 19-year-old donors. Conclusions: While male donors were preferentially utilized, donors with drug use or those deemed Public Health Service Increased Risk were significantly less utilized for heart transplantation. Further consideration of such donors would be appropriate particularly as the demand for transplantation continues to increase.

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“…Similarly, various studies reported beneficial response of DAAs in heart transplant recipients with NAT-positive donors with > 90% SVR12[ 133 , 177 , 178 ]. Kilic et al [ 179 ] and Reyentovich et al [ 180 ] reported no statistically significant differences in 1-year survival in heart recipients transplanted with viremic or aviremic donors.…”

Section: Heart and Lung Transplant Recipientsmentioning

confidence: 98%

Revolution in the diagnosis and management of hepatitis C virus infection in current era

Hanif¹,

Majid²,

Luck³

et al. 2022

WJH

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Chronic hepatitis C virus (HCV) infection is a major global public health problem, particularly in developing part of the world. Significant advances have been made in the early diagnosis and treatment of the disease. Its management has been particularly revolutionized during the past two decades. In this review, we summarize the major advances in the diagnostic and management armamentarium for chronic HCV infection. The focus of the present review is on the newer directly acting anti-viral agents, which have revolutionized the management of chronic HCV infection. Management of uncomplicated chronic HCV infection and of specific complications and special at-risk populations of patients will be covered in detail. Despite the advent and approval of highly effective and well tolerable oral agents, still many challenges remain, particularly the affordability, the equitable distribution and access to later drugs. The World Health Organization aims to eliminate viral hepatitis including HCV by 2030 since its poses a major public health threat. There is an urgent need to ensure uniform and early access to diagnostic and therapeutic facilities throughout the world if the later goal has to be realized.

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Hepatitis C Positive Organ Donation in Heart Transplantation

Cited by 12 publications

References 36 publications

Utilization of hepatitis C virus infected donors in heart transplant recipients with elevated MELD‐XI score

Utilization of hepatitis C virus infected donors in heart transplant recipients with elevated MELD‐XI score

Donor Utilization in the Recent Era: Effect of Sex, Drugs, and Increased Risk

Revolution in the diagnosis and management of hepatitis C virus infection in current era

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