Early outcomes using hepatitis C–positive donors for cardiac transplantation in the era of effective direct-acting anti-viral therapies

Kelly H. Schlendorf, Sandip Zalawadiya, Ashish S. Shah, Mark Wigger, Chan Y. Chung, Sarah Smith, Matthew Danter, Chun W. Choi, Mary E. Keebler, D. Marshall Brinkley, Suzanne Brown Sacks, Henry Ooi, Roman Perri, Joseph A. Awad, Samuel Lewis, Rachel Hayes, Heather O'Dell, Callie Darragh, Alicia Carver, Cori EdmondsShelley Ruzevich-Scholl, Jo Ann Lindenfeld

Research output: Contribution to journalArticlepeer-review

96 Scopus citations

Abstract

Background: Given the shortage of suitable donor hearts for cardiac transplantation, and the favorable safety and efficacy of current agents used to treat hepatitis C virus (HCV), our institution recently piloted transplantation of select patients using HCV-positive donors. Methods: Between September 2016 and March 2017, 12 HCV-naive patients and 1 patient with a history of treated HCV underwent heart transplantation (HT) using hearts from HCV-positive donors after informed consent. Patients who acquired HCV were referred to hepatology and treated with direct-acting anti-viral therapies (DAAs). Data collection and analysis were performed with institutional review board approval. Results: At the time of HT, mean age of recipients was 53 ± 10 years, and 8 patients (61.5%) were on left ventricular assist device support. After consent to consider an HCV-positive heart, mean time to HT was 11 ± 12 days. Nine of 13 patients (69%) developed HCV viremia after transplant, including 8 who completed DAA treatment and demonstrated cure, as defined by a sustained virologic response 12 weeks after treatment. One patient died during Week 7 of his treatment due to pulmonary embolism. DAAs were well tolerated in all treated patients. Conclusions: In the era of highly effective DAAs, the use of HCV-positive donors represents a potential approach to safely expand the donor pool. Additional follow-up is needed to elucidate long-term outcomes.

Original languageEnglish (US)
Pages (from-to)763-769
Number of pages7
JournalJournal of Heart and Lung Transplantation
Volume37
Issue number6
DOIs
StatePublished - Jun 2018
Externally publishedYes

Keywords

  • direct-acting antiviral therapy
  • donor shortage
  • heart transplantation
  • hepatitis C
  • hepatitis C-positive donors

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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