8 reports on safety of HCV positive-to-negative organ transplants

The “direct-acting antiviral era” for hepatitis C has been a novel step forward in medicine with several regimens providing cure rates of 95% or higher and many available as secondary treatments for patients whose initial treatment failed. With this highly curative option, researchers have focused on evaluating opportunities to use hepatitis-C infected organs to increase the transplant donor pool.

Healio Gastroenterology and Liver Disease presents eight reports on data showing safety and efficacy of transplanting HCV-positive organs into HCV-negative recipients, including both preventative therapy and posttransplant treatment for heart, kidney, and liver transplantations.

HCV-Positive Organs: A Viable Option for Uninfected Transplant Patients

The number of hepatitis C-infected organs viable for transplantation has increased in recent years in correlation with the increasing opioid epidemic. While it is common practice to offer HCV-positive organs to patients already infected, especially liver disease patients, researchers have started looking into their use in uninfected patients. This option has become viable thanks to the high success rate of treatment with direct-acting antivirals.

“We’ve been using HCV-positive organs since the early days of transplant, but we would always give them to HCV-positive individuals,” Norah Terrault, MD, from the University of California in San Francisco, told Healio Gastroenterology and Liver Disease. “Since we have a lot of patients on the waitlist with HCV, there has always been a home for those organs.” READ MORE

Combination therapy prevents HCV infection in non-viremic organ recipients

Hepatitis C infection was prevented or rapidly cured in transplant recipients who received organs from donors infected with the virus following combined treatment with ezetimibe and direct-acting antiviral therapy, according to study results presented at The Liver Meeting 2019.

“Unfortunately, most of you know that the opioid epidemic continues and, with that, an overdose crisis,” Jordan J. Feld, MD, MPH, FAASLD, from the University of Toronto University Health Network, said during a press conference. “What has been observed is that among potential organ donors, particularly those who died of overdose, the prevalence of hepatitis C has increased dramatically.” READ MORE

Treatability of HCV from heart transplants may broaden donor pool

The donor pool for heart transplants can potentially be expanded now that the infection from donor-derived hepatitis C is curable and well tolerated, according to a study published in JAMA Cardiology.

“While multiple centers have reported their preliminary findings using hepatitis C-positive donors in small numbers of patients, ours is the first to report longer-term outcomes (including 1-year survival) in a much larger cohort (80 patients total),” Kelly H. Schlendorf, MD, assistant professor of medicine and medical director of the adult heart transplant program at Vanderbilt University Medical Center in Nashville, Tennessee, told Healio. READ MORE

HCV-positive transplants into aviremic patients safe for multiple organs

Data from a large, real-world study contributed to the growing safety and efficacy evidence of transplanting hepatitis C-infected organs into aviremic patients in the direct-acting antiviral era.

“The introduction of direct-acting antiviral agents (DAAs) has led to a paradigm shift in the way HCV is approached. Several studies have now demonstrated their efficacy and safety in the posttransplant population,” Nikhil Kapila, MD, from the Cleveland Clinic in Florida and colleagues wrote. “More recently, HCV viremic allografts have been utilized successfully in viremic recipients, however their use in aviremic recipients is an area of intense interest.” READ MORE

High cure rates follow HCV positive-to-negative heart transplants

Hepatitis C virus-negative candidates who receive transplants with HCV-infected hearts experience acceptable outcomes and high cure rates, according to recently published study findings.

“The study was prompted by our deep concern that the lack of organs for transplantation puts a tremendous burden on patients with advanced heart disease. The opiate crisis has driven a large spike in the number of individuals who die from a drug overdose and with hepatitis C virus infection,” Peter P. Reese, MD, MSCE, associate professor of medicine at Perelman School of Medicine at the University of Pennsylvania, told Infectious Disease News. READ MORE

HCV positive-to-negative kidney transplant cost-effective vs. waiting

Transplantation with hepatitis C nucleic acid test-positive kidneys in HCV-negative recipients followed by direct-acting antiviral therapy demonstrated improved patient outcomes and significant cost-savings, according to results of a recent modelling study.

“The findings indicate that it is cost-saving to consider the use of HCV NAT-positive kidneys for waitlist candidates in whom the waiting time for transplantation would be shortened by 2 years in the context of a clinical study,” Matthew Kadatz, MS, from the University of British Columbia in Vancouver, Canada, and colleagues wrote. READ MORE

Transplantation of hearts from donors with HCV safe

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. READ MORE

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.” READ MORE