Increased early acute cellular rejection events in hepatitis C-positive heart transplantation

Gidea, C.; Narula, Navneet; Reyentovich, Alex; Fargnoli, Anthony S.; Smith, Deane E.; Pavone, J.; Lewis, Tyler; Karpe, Hannah; Stachel, Maxine W.; Rao, Shaline; Moreira, Alexandra; Saraon, Tajinderpal; Raimann, Jochen G.; Kon, Zachary N.; Moazami, Nader

doi:10.1016/j.healun.2020.06.022

Cited by 40 publications

(39 citation statements)

References 27 publications

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“…However, several details of this approach to HT warrant further investigation. The majority of HT recipients from HCV‐viremic donors develop viremia and a recent single‐center report showed an increased rate and severity of early acute cellular rejection, during the period of transient recipient viremia 9 . These episodes occurred earlier in the NAT‐positive compared with the NAT‐negative recipient group, independent of tacrolimus levels, and the results were maintained at six months of follow‐up.…”

Section: Discussionmentioning

confidence: 94%

Effect of Hepatitis C donor status on heart transplantation outcomes in the United States

Doulamis

Tzani

Moustakidis³

et al. 2021

Clinical Transplantation

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A potential donor for heart transplantation (HT) is required to meet several selection criteria including negative viral serologies for hepatitis B surface antigen, hepatitis C virus (HCV), and human immunodeficiency virus. A small number of HCV-viremic donors have been transplanted into HCV-negative recipients because of concerns of viral transmission, risk of cirrhosis in the setting of chronic maintenance immunosuppression, poor tolerability of interferon-based therapy and low sustained virologic response (SVR) rates. However, recent evidence on the safety and efficacy of direct-acting antiviral (DAA) therapies for HCV has resulted in the development of alternative strategies to expand the supply of donor organs. Specifically, the use of HCVpositive donors for cardiac transplantation is under investigation as a potential means of expanding the donor pool with excellent SVR and accumulating evidence on safety of this approach. [1][2][3][4][5]

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Section: Discussionmentioning

confidence: 94%

Effect of Hepatitis C donor status on heart transplantation outcomes in the United States

Doulamis

Tzani

Moustakidis³

et al. 2021

Clinical Transplantation

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“…While a number of studies have explored patient and graft survival after use of HCV + donors for HT, the data on other transplant associated outcomes like rejection and CAV have been more limited. Although several of the aforementioned single-center studies and registries reported no differences in these outcomes [20, 24•, 25•, 26•], a single-center report by Gidea and colleagues reported that among 50 HT recipients in the DAAT era, including 22 with NAT + donors and 28 with NAT − donors, recipients of NAT + hearts had a significantly higher rate of treated acute cellular rejection (ACR) at 60 and 180 days, as well as a lower median time to occurrence of first rejection event [27]. The small numbers of patients in each arm as well as the retrospective nature of the study are important caveats in the interpretation of these results, and this area is deserving of further study.…”

Section: Hepatitis C Positive Organs In Heart Transplant Recipients-the New Eramentioning

confidence: 99%

Hepatitis C Positive Organ Donation in Heart Transplantation

Siddiqi

Schlendorf

2021

Curr Transpl Rep

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“…Since 2017, multiple clinical series have demonstrated the safety and efficacy of HCV+ to HCV– (HCV D+/R–) organ transplantation, with the cure rates for donor‐derived HCV infection approaching 100% 1,2,6–11 . However, significant adverse events such as fibrosing cholestatic hepatitis and acute rejection have been reported 12–15 . While these events are rare, transplant centers, recipients, and caregivers must be aware of these risks.…”

Section: Introductionmentioning

confidence: 99%

Caregiver exposure to hepatitis C virus following transplantation with hepatitis C viremic donor organs: A case series

Kim

Stern

Weldon

et al. 2022

Transplant Infectious Dis

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Direct-acting antiviral (DAA) therapeutics have ushered in an era in which transplanting organs from donors infected with hepatitis C virus (HCV+) into recipients without (HCV-) is an increasingly common practice. Rare but potentially life-threatening events have been reported in recipients of HCV+ organs. Since 2018 at our institution, 182 HCV-patients have received HCV+ donor organs. Here, we retrospectively reviewed cases in which recipients' family member caregivers reported sustaining needlestick exposures at home following discharge of the transplant recipient from the hospital. Caregiver needlestick exposures were passively reported in three cases of HCV+ into HCV-transplants (1.64% of such cases at our center). In all instances, the exposed individuals were aiding in diabetic management and the exposure occurred via lancets or insulin needles. In one case, the recipient viral load was undetectable at the time of the exposure but in the other two, recipients were viremic, putting their family members at risk to contract HCV infection. Surveillance for the exposed individuals was undertaken and no transmissions occurred. For centers performing HCV+ into HCV-transplants, it is important that informed consent includes discussion of potential secondary risks to family members and caregivers. Further, protocols for postexposure surveillance and for the acquisition of DAA treatment in the event of a secondary transmission should be in place.

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Increased early acute cellular rejection events in hepatitis C-positive heart transplantation

Cited by 40 publications

References 27 publications

Effect of Hepatitis C donor status on heart transplantation outcomes in the United States

Effect of Hepatitis C donor status on heart transplantation outcomes in the United States

Hepatitis C Positive Organ Donation in Heart Transplantation

Caregiver exposure to hepatitis C virus following transplantation with hepatitis C viremic donor organs: A case series

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