12 June 2020 : Original article
Heart Transplant Using Hepatitis C-Seropositive and Viremic Organs in Seronegative Recipients
Yuanjia Zhu1ABCDEF, Yasuhiro Shudo1ADEF, Roy Lee23DEF, Y. Joseph Woo1ADEFG*DOI: 10.12659/AOT.922723
Ann Transplant 2020; 25:e922723
Abstract
BACKGROUND: Hepatitis C virus (HCV)-seropositive donor hearts are underutilized for orthotopic heart transplantation (OHT). The advancement of direct-acting antiviral agent (DAA) treatment for HCV makes utilizing HCV-seropositive and viremic donor organs in HCV-seronegative recipients a possibility.
MATERIAL AND METHODS: From 1997 to 2019, adult patients who underwent OHT at our institution were retrospectively reviewed. Ten HCV-seronegative patients received HCV-seropositive donor hearts, 3 of which tested nucleic acid-positive. Kaplan-Meier curves were performed for survival analyses. This study was approved by the Institutional Review Board.
RESULTS: Recipient median age was 57.5 years old, and 2 (20%) were female. Donor median age was 42 years old, and 3 (30%) were female. One donor was cured from HCV with DAA prior to OHT. Four recipients developed hepatitis C viremia immediately after OHT. DAA treatment was completed in 3 recipients who demonstrated cure. Thirty-day and 1-year survival rates were both 80%.
CONCLUSIONS: We describe 10 HCV-seronegative patients who received HCV-seropositive donor hearts at our institution, with excellent short-term outcomes, even in those who received nucleic acid testing positive organs. DAA can be effective in treating hepatitis C viremia before and after OHT, with excellent recipient survival. Large clinical studies are needed to further evaluate the long-term outcomes of DAA therapy in patients after heart transplantation.
Keywords: Antiviral Agents, Heart Transplantation, Hepacivirus, Hepatitis C, Tissue and Organ Procurement, transplant recipients, Viremia
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