Use of hepatitis C virus-positive (HCV+) organs for heart transplantation (HT) in recipients who are HCV-negative (HCV-) is feasible with excellent short-term outcomes, according to single-center study results published in The Journal of Heart and Lung Transplantation.1

Since 2000, the rate of drug overdose deaths has increased by 137% and the incidence of acute HCV infection has also increased due to the opioid epidemic.1 HCV+ organs are commonly used for transplant into HCV+ recipients with studies demonstrating excellent outcomes when treatment for HCV has occurred after transplant in recipients for livers and kidneys.2,3 There is increasing interest in using HCV+ organs for transplantation into recipients who are HCV-.

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At the University of California San Diego, researchers retrospectively reviewed the outcomes of HT with HCV+ organs in 21 recipients who were HCV-.1 They found that 19 donors were viremic and 2 were nonviremic; 18 patients underwent HT alone, while 3 underwent combined heart-kidney transplantation.  While there was no HCV transmission from the 2 donors who were nonviremic, all 19 recipients of the donors who were viremic developed HCV infection. However, all 19 patients who received a 12-week course of direct antiviral agent therapy cleared the viremia and the sustained virologic response rate at 12 weeks in 18 evaluable patients was 100%.

“In conclusion, we demonstrate the feasibility and success of using HCV+ organs for HT with excellent short-term outcomes from a single center,” stated the investigators.1 They added that, “Caution and close follow-up are needed to ascertain the development of adverse events, in particular transaminitis, in the setting of acute HCV infection.”

Disclosure: Some study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

References

1. Aslam S, Yumul I, Mariski M, Pretorius V, Adler E. Outcomes of heart transplantation from hepatitis C virus−positive donors [published online August 24, 2019]. J Heart Lung Transplant. doi:10.1016/j.healun.2019.08.019

2. Chen K, Lu P, Song R, et al. Direct-acting antiviral agent efficacy and safety in renal transplant recipients with chronic hepatitis C virus infection: a PRISMA-compliant study. Medicine (Baltimore). 2017;96:e7568.

3. Saxena V, Khungar V, Verna EC, et al. Safety and efficacy of current direct-acting antiviral regimens in kidney and liver transplant recipients with hepatitis C: results from the HCV-TARGET study. Hepatology. 2017;66:1090-1101.