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Heart transplant with HCV-positive organs successful, virus cleared

Patients without hepatitis C who underwent heart transplantation with an HCV-positive organ were likely to develop HCV viremia posttransplant, but had high rates of sustained virologic response following direct-acting antiviral therapy, according to published results of a recent prospective study.

“Given the shortage of donor hearts available for transplantation, and the favorable safety and efficacy of DAAs used to treat HCV, our institution piloted transplantation of selected patients using HCV-positive donors,” Kelly H. Schlendorf, MD, from the Vanderbilt University Medical Center in Tennessee, and colleagues wrote.

Beginning in September 2016, Schlendorf and colleagues enrolled 12 HCV-naive patients and one patient with a history of HCV that was cured before listing in the study. Patients elected to undergo heart transplantation with organs from HCV-positive donors.

Waitlist time varied based on recipient consent to receive an HCV-positive heart, with a median time of 256 days (range, 1-202 days).

Nine patients developed HCV viremia posttransplant and underwent subsequent treatment with DAAs. All nine patients received organs from donors with detectable HCV antibody and positive nucleic acid amplification test results. Median time from transplant to detection of viremia was 4 days (range, 2-13 days).

As of October 2017, eight patients completed 12 weeks of DAA therapy and demonstrated sustained virologic response. One patient died due to pulmonary embolism during week 7 of treatment.

“Ongoing follow-up will allow us to better assess the safety and efficacy of transplanting hearts from HCV-positive donors into HCV-negative patients,” Schlendorf and colleagues wrote. “There are ongoing questions as to the effect, if any, HCV infection or DAA therapy have on graft function, endothelial function, incidence of rejection, CAV, renal and hepatic function, and survival. If utilization of HCV-positive donors proves to be safe and efficacious in the long term, there is a potential for this strategy to have a major impact on reducing morbidity and mortality of waitlisted patients.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.