Successful heart‐kidney transplantation from a Hepatitis C viremic donor to negative recipient: One year of follow‐up

Wettersten, Nicholas; Tran, Hao; Mekeel, Kristin L.; Pretorius, Victor; Adler, Eric; Aslam, Saima

doi:10.1111/tid.13002

Cited by 6 publications

(7 citation statements)

References 19 publications

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“…Selected epidemiological and descriptive characteristics of the transplant recipients are described in Table 3. Four patients (8%) underwent a multiorgan transplantation, 3 of these patients (6%) received a combined heart-kidney transplant 38,40,45 and 1 patient (2%) received a heart-liver transplant. 34 The majority of patients (n = 16, 47%) received basiliximab as induction.…”

Section: Resultsmentioning

confidence: 99%

Heart Transplantation From Hepatitis C–Positive Donors in the Era of Direct Acting Antiviral Therapy: A Comprehensive Literature Review

Schnegg

Nicole

Dharan

et al. 2019

Transplantation Direct

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Background.While heart transplantation is a highly effective treatment in patients with advanced heart failure, the number of people waiting for a transplant exceeds the number of available donors. With the advent of direct acting antivirals (DAA) for the eradication of Hepatitis C, the heart transplant donor pool has been expanded to include donors with untreated Hepatitis C. To help with the development of future protocols for Hepatitis C–positive heart transplants, we performed a review of the literature on DAA therapy in the context of heart transplantation.Methods.We searched MEDLINE, EMBASE, OVIDE JOURNAL, and GOOGLE SCHOLAR for papers published between 01.01.2011 and 01.06.2019 using key words “heart transplantation” associated with “hepatitis C.”Results.After removing duplicates, we screened 78 articles and retained 16 for primary analysis and 20 for sustained virologic response 12 weeks after completion of the DAA therapy (SVR-12). The data from 62 patients were extracted from these publications. Fifty-six (90%) patients had donor-derived hepatitis C and 6 (10%) patients were chronically infected with hepatitis C before transplantation. All living transplanted patients achieved SVR-12, defined as hepatitis C virus RNA below the limit of detection 12 weeks after treatment completion. Treatment duration ranged from 4 to 24 weeks. Clinically relevant modification to the dosing of immunosuppressive mediations during DAA therapy was documented in only 1 patient (1.6%). Six (14%) patients experienced rejection during DAA therapy.Conclusions.Despite different timings of initiation of DAA therapy across the included studies, there were no differences in sustained viral clearance. Early commencement of DAA with a potentially shorter treatment duration (<8 wk) is appealing; however, further studies are required before recommending this approach.

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Section: Resultsmentioning

confidence: 99%

Heart Transplantation From Hepatitis C–Positive Donors in the Era of Direct Acting Antiviral Therapy: A Comprehensive Literature Review

Schnegg

Nicole

Dharan

et al. 2019

Transplantation Direct

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“…Recently, there have been several reports on positive outcomes in patients receiving combined organ transplants (eg, heart/kidney or lung/liver) from HCV-infected donors. 16,18,21 ACCEPTING HCV-INFECTED DONOR ORGANS: PROCEED WITH CAUTION There are several important considerations when using HCV-infected donor organs, as illustrated in Figure 2.…”

Section: Utilization Of Hcv-infected Organs In Transplant Settingsmentioning

confidence: 99%

“…Despite down-trending cost with market competition, DAA therapy can range from $26,400 to $94,500 for an 8-to 12-week course. 21,23 Woolley and colleagues 13 showed that recipients treated within hours of transplantation achieve SVR within 2 weeks, potentially allowing a shorter course of DAA therapy. There have been reported cases of HCV-related complications such as acute glomerulonephritis and cholestatic hepatitis related to delayed access to DAA therapy.…”

Section: Insurance Coveragementioning

confidence: 99%

“…However, early treatment may involve interruption of therapy due to renal dysfunction or inability to take medications by mouth. 21 The benefits of delayed treatment include avoidance of early drug interactions when immunosuppressive agents are not in steady state, time for stabilization of renal function, and the possibility that a small minority (<10% of patients) may clear the virus spontaneously. Disadvantages of delayed treatment include potential complications of HCV viral replication, including acute hepatitis.…”

Section: Length Of Therapymentioning

confidence: 99%

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Treading lightly as we step into a new era: Use of hepatitis C virus-infected organs for transplantation

Moayedi

Gulamhusein

Khush

2020

The Journal of Thoracic and Cardiovascular Surgery

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An unprecedented number of heart transplants were performed in the United States during 2016, 1 yet 15% of patients on the waitlist either died or became too sick for transplant. 2 Wait times remain unacceptably high for heart transplant candidates. As a result, there has been growing interest in the development of innovative strategies to mitigate the donor organ shortage. During the past decade, the opioid epidemic in the United States has led to a dramatic increase in the number of organ donors who died as a result of drug intoxication. 3 Closely associated with this rise, hepatitis C virus (HCV) infection increased by 400% among 18-to 29-year olds and 325% in 30-to 39-year olds during the same time period. 4 Historically, many of these HCVviremic (herein referred to as HCV-infected) donor organs would be discarded due to anticipated poor recipient shortand long-term survival after transplantation. However, mechanistic insights into the replication of HCV have enabled the development of highly effective and well tolerated direct acting antivirals (DAA) for HCV treatment. 5 This article provides an overview of the management of HCV-infected donor organs, highlighting important considerations in the setting of thoracic transplantation. We discuss the current status of using HCV-infected organs for transplantation, the remaining long-term uncertainties of this approach, and novel strategies for using HCVinfected organs. Currently, a minority of HCV-infected organs are accepted for thoracic transplantation. Based on a United Network Organ Sharing registry analysis, only 64 of 1078 HCV-infected donor hearts were accepted for transplantation from 2014 to 2017. 6 These donors had otherwise favorable characteristics: they were young with a median age of 32 years (interquartile range [IQR], 27-37 years) and had significantly fewer comorbidities such as diabetes and hypertension when compared with the general donor population. 6,7 Based on this registry analysis, more than 800 donor hearts were discarded due to HCV infection, which may represent a valuable missed opportunity for critically ill candidates on the waitlist. Many transplant centers, those particularly in United Network Organ Sharing regions 3, 4, 7, 8, 9, and 10 have been very cautious about accepting HCV-infected organs (Figure 1). The treatment of chronic HCV infection has evolved from the highly toxic and poorly tolerated interferon-and ribavirin-containing regimens to the new landscape of DAA agents. 8 There are currently 4 classes of DAAs, each targeting a unique nonstructural viral protein: NS3/NS4A protease inhibitors, inhibitors of the NS5A complex, and inhibitors of the NS5B polymerase that are subdivided into nucleos(t)ide inhibitors and nonnucleos(t) ide inhibitors and differ in individual potency and barriers to resistance. 8,9 In 2014, the Food and Drug Association approved the first interferon and ribavirin-free regimen consisting of a once-daily combination pill (sofosbuvir/ ledipasvir). 8 Early studies in the transplant setting established t...

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“…Although 2 recipients became seropositive for HCV antibody and one recipient had a HCV antibody that was equivocal, there was no evidence of viral transmission in all 14 recipients [53]. Wetterston et al described a case of a HCV negative patient with a left ventricular assist device (LVAD) driveline infection and ESRD on hemodialysis who underwent heart-kidney transplant with organs from a HCV-viremic (NAT positive) donor [55]. The recipient developed HCV viremia (genotype 1a) the day after transplant and was started on a 12week course of elbasvir-grazoprevir at the time of discharge and achieved SVR.…”

Section: Heartmentioning

confidence: 99%

New Frontiers in Solid Organ Transplantation from Donors with Human Immunodeficiency Virus, Hepatitis C Virus Infection, and Multidrug Resistant Organisms

Lum¹,

Mossad²

2018

obm transplant

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Successful heart‐kidney transplantation from a Hepatitis C viremic donor to negative recipient: One year of follow‐up

Cited by 6 publications

References 19 publications

Heart Transplantation From Hepatitis C–Positive Donors in the Era of Direct Acting Antiviral Therapy: A Comprehensive Literature Review

Heart Transplantation From Hepatitis C–Positive Donors in the Era of Direct Acting Antiviral Therapy: A Comprehensive Literature Review

Treading lightly as we step into a new era: Use of hepatitis C virus-infected organs for transplantation

New Frontiers in Solid Organ Transplantation from Donors with Human Immunodeficiency Virus, Hepatitis C Virus Infection, and Multidrug Resistant Organisms

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