Journal article
Outcomes of heart transplantation from hepatitis C virus-positive donors
The Journal of heart and lung transplantation, Vol.38(12), pp.1259-1267
12/01/2019
DOI: 10.1016/j.healun.2019.08.019
PMID: 31521479
Abstract
BACKGROUND: National data demonstrate that increasing opportunities exist for organ donation among hepatitis C virus (HCV)-infected individuals.
METHODS: We developed a clinical practice protocol for the acceptance of HCV+ organs for HCVpatients who underwent heart transplantation (HT) and retrospectively reviewed the outcomes at our institution. Inclusion criteria were as follows: all adult patients listed for HT. Exclusion criteria were as follows: pre-existing HIV or active hepatitis B viremia in the recipient/donor.
RESULTS: We transplanted 21 patients from HCV+ donors. Nineteen were viremic donors, and 2 were non-viremic donors. The recipients included 18 patients who underwent HT alone, and 3 patients who underwent combined heart-kidney transplants. There was no HCV transmission from the non-viremic donors (n = 2). All 19 recipients of the viremic donors developed HCV infection (100% transmission). The median age of the viremic donors was 34 years (interquartile range 30-46), and 84.2% were considered US Public Health Service-increased risk. Induction immunosuppression consisted of antithymocyte globulin (7/21), basiliximab (7/21), or none (8/21). Maintenance immunosuppression comprised tacrolimus, mycophenolate mofetil, and prednisone. Post-operative Week 2 HCV viral load was not related to induction. Direct anti-viral agent (DAA) therapy for a 12-week course consisted of glecaprevir/pibrentasvir (14/19, 74%), sofosbuvir/velpatasvir (2/19, 11%), elbasvir/grazoprevir (2/19, 11%), and ledipasvir/sofosbuvir (1/19, 5%). All the patients on DAA therapy cleared viremia. The sustained virological response rate at 12 weeks in 18 evaluable patients was 100%.
CONCLUSIONS: We report successful single-center experience using HCV+ organs for HT into HCV-recipients. We believe that there is utility in using such organs to expand the current donor pool. Further long-term follow-up is needed. (C) 2019 International Society for Heart and Lung Transplantation. All rights reserved.
Details
- Title: Subtitle
- Outcomes of heart transplantation from hepatitis C virus-positive donors
- Creators
- Saima Aslam - University of California, San DiegoIly Yumul - University of Iowa Hospitals and ClinicsMark Mariski - University of California, San DiegoVictor Pretorius - University of California, San DiegoEric Adler - University of California, San Diego
- Resource Type
- Journal article
- Publication Details
- The Journal of heart and lung transplantation, Vol.38(12), pp.1259-1267
- Publisher
- Elsevier
- DOI
- 10.1016/j.healun.2019.08.019
- PMID
- 31521479
- ISSN
- 1053-2498
- eISSN
- 1557-3117
- Number of pages
- 9
- Language
- English
- Date published
- 12/01/2019
- Academic Unit
- Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984360150002771
Metrics
9 Record Views