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DAA therapy after HCV-positive heart transplant results in 100% SVR

All patients who completed direct-acting antiviral therapy after orthotopic heart transplantation with hepatitis C-positive donor hearts achieved sustained virologic, according to results from a recent study.

“The transplantation of HCV-infected hearts was nearly abandoned in the era of interferon-based HCV treatment regimens,” Rhondalyn C. McLean, MD, from the Perelman School of Medicine at the University of Pennsylvania, and colleagues wrote. “DAAs for HCV subsequently prompted reconsideration of transplanting HCV-infected hearts. Taken together with other studies, [our] results provide further evidence that wider use of HCV-infected organs should be a priority.”

Of the 20 patients who completed informed consent and were activated for HCV-positive heart offers, 10 patients underwent transplantation. The median recipient age was 52.5 years and all donors were under age 40 years. All donor organs were infected with HCV genotype 1a.

The patients all had detectable HCV at 3 days posttransplant and initiated treatment with Zepatier (elbasvir/grazoprevir, Merck) while in hospital.

Nine patients had undetectable HCV according to nucleic acid amplification testing within 4 weeks from the start of HCV therapy. At week 12, all nine achieved SVR. The one patient who did not achieve SVR became HCV-negative within 7 days of starting therapy and remained negative for the duration of treatment but died at 79 days posttransplant due to antibody-mediated rejection.

“While serious adverse events included one death and acute kidney injury requiring prolonged dialysis therapy, these adverse events appeared to be unrelated to HCV or its therapy and instead reflect the general risks of heart transplantation,” McLean and colleagues wrote. “[These] trial results should provide some reassurance that DAA treatments will enable better outcomes with transplantation of HCV-infected hearts than were achieved in the interferon treatment era.” – by Talitha Bennett

Disclosure: McLean reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.