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Transplantation of hearts from donors with HCV safe
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The use of hearts from donors infected with hepatitis C virus significantly expands the donor pool and reduces wait list times for patients awaiting heart transplantation, with recipients of these hearts who develop HCV responding well to treatment, according to data presented at the Annual Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation.
As a result of the opioid epidemic, the rate of HCV is rising, as is the number of potential heart donors who die from drug intoxication, Kelly H. Schlendorf, MD, MHS, medical director of the Adult Heart Transplant Program at Vanderbilt Heart and Vascular Center and assistant professor of medicine at Vanderbilt University Medical Center, said during a presentation.
Vanderbilt developed a protocol for use of hearts from donors with HCV, she said, noting it involves patient education and consent, standard immunosuppression post-transplant, and for patients who develop donor-derived HCV, a 12-week course of treatment with direct-acting antiviral therapies.
“Utilization of HCV-infected donors has had a significant impact in expanding the
donor pool for patients awaiting transplant at our center and elsewhere,” Schlendorf said in a press release. “For many patients, this may translate into reduced morbidity and mortality. A lot remains to be learned, but so far what we’ve learned is exciting.”
Schlendorf presented outcomes from 74 patients (median age, 55 years; median wait-list time, 4 days) who were transplanted with a heart from a donor with HCV between September 2016 and March 2019; 60 of these patients acquired donor-derived HCV infection.
Among the 60 patients with donor-derived HCV, 74% had HCV genotype 1, the median number of days from transplantation to detectable HCV viral load was 5, and patients began treatment with direct-acting antiviral medications a median of 55 days after transplantation, according to the researchers. The most common treatment regimen (50%) used was ledipasvir/sofosbuvir (Harvoni, Gilead Sciences).
In the cohort of 60 patients with donor-derived HCV, 41 patients to date have completed HCV treatment, all of whom have achieved viral clearance, Schlendorf said. Among the rest, therapy is presently ongoing in 12 patients and has not yet been initiated in two patients who were recently transplanted. In five other patients, therapy was unable to be initiated or completed due to patient death — four patients died due to primary graft failure and one patient died due to autopsy-proven pulmonary embolism. There have been no treatment failures to date, Schlendorf said.
Among patients with donor-derived HCV, rates of 30-day and 1-year survival were 95% and 90.2%, respectively, she said, noting the rates are not significantly different than those of patients without donor-derived HCV.
There were also no major challenges in obtaining drug coverage, she said.
“HCV-infected donors offer a feasible strategy to expand the donor pool and reduce wait-list times,” Schlendorf said during the presentation. “Further work is needed to elucidate ideal timing and duration of treatment, and long-term outcomes.” – by Erik Swain
Reference:
Schlendorf KH, et al. Abstract 96. Presented at: Annual Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation; April 3-6, 2019; Orlando.
Disclosure: Schlendorf reports no relevant financial disclosures.