番茄社区

Heart transplants from hepatitis C virus (HCV)-positive donors did typically result in infection of the recipient but without harming outcomes, a single-center study showed.

Among 70 cases where the donor tested positive for HCV antibody or HCV nucleic acid, 67 (95.7%) recipients tested positive as well over a median follow-up of 301 days post-transplant.

All of these donor-infected patients had a sustained virologic response to direct-acting antivirals, Kelly Schlendorf, MD, of Vanderbilt University Medical Center in Nashville, Tennessee, and colleagues .

Patient survival at 1 year was:

• 90.4% for those infected by their infected donor (five died from primary graft failure before starting HCV therapy, and one from pulmonary embolism at 112 days after transplant, during HCV treatment)
• 91.7% for those with an infected donor but not infected themselves (P=0.79 vs HCV-infected recipients)
• 90.5% for those with a donor not infected with HCV (P=0.88 vs HCV-positive donor recipients)

Allograft rejection episodes requiring treatment occurred in 16.4% of the donor-infected heart recipients and 15.4% of the 13 whose donor had HCV but didn't contract the virus themselves (P>0.99).

"At a time when the discrepancy between organ supply and organ demand continues to increase, our findings suggest that use of these donors is an effective way to increase the donor pool, thereby increasing transplant volumes and reducing the morbidity and mortality of patients awaiting HT," Schlendorf's group wrote.

A acknowledged this as a potential help to the thousands of waitlisted heart transplant candidates annually who face a 10% mortality rate while waiting for an organ to come available.

"Nearly 70% of available donor hearts are not used for transplant," Kiran Khush, MD, of Stanford University in Stanford, California, and colleagues wrote. "Transplanting hearts from hepatitis C-viremic donors has been a major advance, made possible by the advent of highly effective antivirals."

However, Schlendorf and colleagues cautioned that more data is needed on "longer-term outcomes, specifically CAV [coronary allograft vasculopathy], to guide the optimal timing and duration of HCV treatment and better inform wait-listed patients and their clinicians as they consider this option."

Studies from before the direct-acting antiviral era linked HCV to endothelial dysfunction and atherosclerosis, "and it is conceivable that even transient periods of HCV viremia in the donor and recipient may contribute to an inflammatory state that provokes accelerated intimal thickening in the coronary tree," they noted.

Of the 29 donor-derived HCV patients with coronary angiography at 1 year after transplant for vasculopathy surveillance, 31.0% had signs of it, typically grade 1 on the International Society for Heart and Lung Transplantation scale. None died or required retransplant because of CAV.

Hospitalization duration after transplant was similar among groups, and no hospitalizations occurred related to HCV or its treatment.

"Because our center is surrounded by donation service areas located near the epicenter of the opioid crisis, our experience with increasing HT [heart transplant] volumes and achieving short wait times using HCV-positive donors may not be easily generalizable to other centers across the country, particularly those located in regions where there is less incidence of death due to drug overdose and presumably fewer donors with HCV infection," the researchers noted.

Their prospective study included 80 adult recipients of hearts from hepatitis C-positive donors from September 2016 to April 2019 at Vanderbilt's large academic medical center.

Notably, median active wait-list time from consent to a HCV-positive donor heart to actually getting one was just 4 days whereas it was already 28 days before that consent for those who had already accrued wait time.

Comment