Outcomes of heart transplantation from hepatitis C virus–positive donors

Outcomes of the Treatment with Glecaprevir/Pibrentasvir following heart transplantation utilizing hepatitis C viremic donors

“…By comparison to compiled studies, 23 this is one of the larger series of heart transplants performed utilizing hepatitis C viremic donors. Multiple centers including ours have demonstrated when transplanting hearts from viremic donors into HCV naive recipients, the result is a rapid rise in viral titers in the early post‐operative course 8,9 . Moreover, in our limited n = 2 (NAT−/Ab+) transplants no HCV viremia was detected in these recipients.…”

“…As in other centers, 9,16 we experienced relatively minor issues with GLE/PIB in the context of post‐operative complications and or co‐morbidities. GLE/PIB's safety profile in the context of complex multi‐organ transplantation involving HCV‐VIR is also another significant topic requiring more exploration, and however, we presented individual cases.…”

“…This center planned this administration as an investigational new drug exemption with the FDA, and as we did assume the entire cost of the DAA. Aslam et al 9 delayed initiation of DAA as far out to the outpatient setting of 12 weeks and administered a range of regimens customized for each patient based on input from hepatology formularies. In our patients, viremia peaked at 1 week and cleared on average 2‐3 weeks after initiation of therapy with no recurrence.…”

“…Previous trials 8‐10 demonstrated that the risk of HCV transmission, specifically from donors with confirmed viremic status into hepatitis C naive patients is nearly 100%. This exposes the recipient to potentially compromising immune activation induced by development of HCV viremia 11‐13 .…”

EASL recommendations on treatment of hepatitis C: Final update of the series☆

“…Positive results have also been reported in heart transplant recipients grafted with an HCV RNA-positive organ. 215,[218][219][220] In an open-label study, preemptive administration of glecaprevir/ pibrentasvir resulted in expedited organ transplantation, rapid HCV suppression, prevention of chronic HCV infection and excellent early allograft function in patients receiving HCVinfected donor hearts. 221 In another study, 36 patients received lung transplantation and 8 received heart transplantation from HCV-infected donors.…”