Hepatitis C Virus Seropositivity in Organ Donors and Survival in Heart Transplant Recipients

Gasink, Leanne B.; Blumberg, Emily A.; Localio, A. Russell; Desai, Shashank; Israni, Ajay K.; Lautenbach, Ebbing

doi:10.1001/jama.296.15.1843

Cited by 145 publications

(115 citation statements)

References 21 publications

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“…Maximal intimal thickness greater than 0.5 millimeters at one month after transplant is a strong independent predictor of mortality at one year [157,158,160]. Hepatitis B and C seropositive status of the donor is noted to be associated with higher rates of CAV in the heart transplant recipients [161,162].…”

Section: Donor Factorsmentioning

confidence: 95%

Cardiac Allograft Vasculopathy: A Review of Risk Factors and Pathogenesis

Munagala¹,

Phancao²

2018

obm.transplant

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Heart transplant remains the gold standard therapy for patients with end stage heart disease and offers improved survival and quality of life. Significant progress has been achieved in improving one-year mortality after heart transplantation. Nonetheless, longterm graft survival has not changed significantly over the past few decades. Long term survival of heart transplant recipients is limited by chronic rejection, cardiac allograft vasculopathy (CAV), and malignancy. CAV is a major contributor for graft failure and mortality after the first year of in heart transplant recipients. CAV is a proliferative vasculopathy characterized by diffuse myointimal hyperplasia and progressive narrowing of the graft vessels. Both immune dependent and independent factors have been shown to contribute to the pathogenesis of CAV. Understanding these risk factors is essential in developing preventative and therapeutic strategies. Angiography with Intravascular ultrasound has become the key diagnostic tool in the early detection of CAV as well as prognostication. Echocardiographic assessment of allograft function in conjunction with coronary angiographic findings are used in assessing the severity of CAV. Adjustment of immunosuppression and statins remain the initial steps in the management of CAV. Retransplantation is the definitive treatment for severe CAV, however, the paucity of organs along with increased mortality associated with retransplantation makes it a less desirable option. Remarkable progress has been achieved in the understanding of pathogenesis, risk factors for CAV and plaque morphology. Nevertheless, significant knowledge gaps persist in scientific understanding of risk factors, pathogenesis, prevention and treatment of CAV. Further research is warranted to fill these gaps, develop diagnostic modalities to facilitate early detection of CAV, and management strategies to Improve graft tolerance and immune modulation. This review focuses on summarizing the pathogenesis and risk factors for CAV.

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Section: Donor Factorsmentioning

confidence: 95%

Cardiac Allograft Vasculopathy: A Review of Risk Factors and Pathogenesis

Munagala¹,

Phancao²

2018

obm.transplant

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“…Among heart donors, ethnicity was not associated with HCV. 133 Black race was associated with increased rates of HCV compared with white race in two blood donor studies, 131,140 of which one was an independent finding.…”

Section: Demographic Factorsmentioning

confidence: 96%

“…In univariate analyses, a history of tobacco use was associated with HCV in heart donors 133 and cigarette smoking was associated with HCV in corneal donors. 118 Among actual heart donors, 36% had a history of tobacco use, 133 and the evidence was rated low quality.…”

Section: Additional Various (Sexual) Associations Unpro-mentioning

confidence: 99%

“…An organ donor study found that HCV infection was associated with older median age. 133 One blood donor study associated HCV with older mean age 130 while the other did not. 131 In general population studies, HCV was associated with increased mean age 141 and decade of birth (with people born from 1940 to 1959 having the highest prevalence), 132 but not age ,50 years 120 or age ,60 years.…”

Section: Demographic Factorsmentioning

confidence: 99%

See 1 more Smart Citation

PHS Guideline for Reducing Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Transmission through Organ Transplantation

et al. 2013

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“…Hepatitis C infection (HCV) in donor hearts increases recipient mortality with mortality rates in one study of 16.9% at 1 year, 41.8% at 5 years, and 50.6% at 10 years, compared to recipients of hepatitis C negative donors who had 8.2%, 18.5%, and 24.3% mortality, respectively (Gasink et al, 2006). Recipients with HCV-positive donor hearts were more likely to die secondary to CAV.…”

Section: Donor Factorsmentioning

confidence: 99%