December 18, 2019
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Treatability of HCV from heart transplants may broaden donor pool

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Kelly H. Schlendor

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.

The survival rates at 1 year were also similar in patients with and without donor-derived HCV, according to the study.

“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. “Our findings reinforce the growing consensus among the transplant community that in the area of direct-acting antiviral therapies, hepatitis C-positive donors offer a very viable strategy to expand the donor pool and potentially reduce waitlist times, morbidity and mortality.”

Researchers analyzed data from 80 patients (median age, 55 years; 71% men; 69% white) who underwent heart transplants with HCV-positive donors between September 2016 and April 2019. Patients were educated before their transplant about HCV and donors with the virus, the lack of long-term data in this area and the high likelihood of disease transmission.

Surveillance endomyocardial biopsies and coronary angiography were performed at 1 year after heart transplantation to monitor for coronary allograft vasculopathy. The HCV genotype was also tested throughout the study.

Data from patients who received hearts from donors with HCV were compared with those who received hearts from HCV-negative donors, which included the occurrence of rejection, graft dysfunction, death and graft vasculopathy.

The median waitlist time for heart transplant after patients consented to accept hearts from donors with HCV was 4 days.

Of the patients who received donors with negative nucleic acid testing results (12.5%), none developed donor-derived HCV. During a median follow-up of 301 days, 95.7% of patients who received donors with positive nucleic acid testing results developed HCV.

Direct-acting antivirals were well tolerated and resulted in sustained virologic responses.

At 1 year, the survival rate for patients who developed HCV after heart implantation was similar to those who did not develop HCV (90.4% vs. 91.7%; P = .79).

“Further research is needed to clarify ideal timing of hepatitis C treatment in these patients and to what extent, if any, donor-derived hepatitis C infection in the era of direct-acting antivirals may contribute to accelerated graft vasculopathy,” Schlendorf said in an interview. “Hopefully with time and technology, we will find ways to treat or inactivate hepatitis C virus prior to the heart being sewn into the recipient. Work is already underway in this area in lung transplantation.” – by Darlene Dobkowski

For more information:

Kelly H. Schlendorf, MD, can be reached at Department of Heart Failure and Transplant Cardiology, Vanderbilt University Medical Center, 1215 21st Ave. S, Room 5209, Nashville, TN 37232; email: kelly.h.schlendorf@vumc.org.

Disclosures: Schlendorf reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.