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Cardiovascular Medicine and Surgery
Use of hepatitis C donors in thoracic organ transplantation: Reportedly associated with increased risk of rejection
Mark Jay Zucker, MD, JD, FCCP
Vice-Chair
Transplanting organs from hepatitis C (HCV) antibody and/or antigen-positive donors is associated with a greater than 8%-90% likelihood that the recipient will acquire the infection. Several studies reported that if HCV conversion happened, the outcomes in both heart and lung recipients were worse, even if treated with interferon/ribavirin (Haji SA, et al J Heart Lung Transplant. 2004;23:277; Wang BY, et al. Ann Thorac Surg. 2010 May;89[5]:1645; Carreno MC, et al. J Heart Lung Transplant. 2001;20(2):224). Thus, despite the shortage of thoracic organ donors and high wait-list mortality, the practice was strongly discouraged.
In 2016, the successful use of a direct-acting antiviral (DAA) for 12 weeks to eliminate HCV in a lung transplant recipient of a seropositive organ was published (Khan B, et al. Am J Transplant. 2017;17:1129). Two years later, the outcomes of seronegative heart (n=8) or lung (n=36) transplant recipients receiving organs from seropositive donors were presented (Woolley AE, et al. N Engl J Med. 2019;380:1606). Forty-two of the patients had viremia within days of the operation. All patients were treated with 4 weeks of a DAA and, of the 35 patients available for 6-month analysis, viral load was undetectable in all. Of concern, however—more cellular rejection requiring treatment was seen in the lung recipients of HCV+ donors compared with recipients of HCV- donors. The difference was not statistically significant.
The largest analysis of the safety of HCV+ donors in HCV- thoracic organ transplant recipients involved 343 heart transplant recipients (Kilic A, et al. J Am Heart Assoc. 2020;9(2):e014495). No differences were noted in outcomes, strokes, need for dialysis, or incidence of treated rejection during the first year. However, the observation regarding rejection was not subsequently confirmed by the NYU team (Gidea CG, et al. J Heart Lung Transplant. 2020;39:1199). Of 22 HCV- recipients of an HCV donor with viremia, the rate of rejection was 64% vs 18% in 28 patients receiving a donor without viremia (through day 180 (P=.001)).
In summary, the ability of DAAs to render 97%-99% of immunosuppressed transplant recipients HCV seronegative has transformed the landscape and HCV viremia in the donor (or recipient) and is no longer an absolute contraindication to transplantation. However, more information is needed as to whether there is an increased incidence of rejection.
Cardiovascular Medicine and Surgery
Use of hepatitis C donors in thoracic organ transplantation: Reportedly associated with increased risk of rejection
Mark Jay Zucker, MD, JD, FCCP
Vice-Chair
Transplanting organs from hepatitis C (HCV) antibody and/or antigen-positive donors is associated with a greater than 8%-90% likelihood that the recipient will acquire the infection. Several studies reported that if HCV conversion happened, the outcomes in both heart and lung recipients were worse, even if treated with interferon/ribavirin (Haji SA, et al J Heart Lung Transplant. 2004;23:277; Wang BY, et al. Ann Thorac Surg. 2010 May;89[5]:1645; Carreno MC, et al. J Heart Lung Transplant. 2001;20(2):224). Thus, despite the shortage of thoracic organ donors and high wait-list mortality, the practice was strongly discouraged.
In 2016, the successful use of a direct-acting antiviral (DAA) for 12 weeks to eliminate HCV in a lung transplant recipient of a seropositive organ was published (Khan B, et al. Am J Transplant. 2017;17:1129). Two years later, the outcomes of seronegative heart (n=8) or lung (n=36) transplant recipients receiving organs from seropositive donors were presented (Woolley AE, et al. N Engl J Med. 2019;380:1606). Forty-two of the patients had viremia within days of the operation. All patients were treated with 4 weeks of a DAA and, of the 35 patients available for 6-month analysis, viral load was undetectable in all. Of concern, however—more cellular rejection requiring treatment was seen in the lung recipients of HCV+ donors compared with recipients of HCV- donors. The difference was not statistically significant.
The largest analysis of the safety of HCV+ donors in HCV- thoracic organ transplant recipients involved 343 heart transplant recipients (Kilic A, et al. J Am Heart Assoc. 2020;9(2):e014495). No differences were noted in outcomes, strokes, need for dialysis, or incidence of treated rejection during the first year. However, the observation regarding rejection was not subsequently confirmed by the NYU team (Gidea CG, et al. J Heart Lung Transplant. 2020;39:1199). Of 22 HCV- recipients of an HCV donor with viremia, the rate of rejection was 64% vs 18% in 28 patients receiving a donor without viremia (through day 180 (P=.001)).
In summary, the ability of DAAs to render 97%-99% of immunosuppressed transplant recipients HCV seronegative has transformed the landscape and HCV viremia in the donor (or recipient) and is no longer an absolute contraindication to transplantation. However, more information is needed as to whether there is an increased incidence of rejection.
Cardiovascular Medicine and Surgery
Use of hepatitis C donors in thoracic organ transplantation: Reportedly associated with increased risk of rejection
Mark Jay Zucker, MD, JD, FCCP
Vice-Chair
Transplanting organs from hepatitis C (HCV) antibody and/or antigen-positive donors is associated with a greater than 8%-90% likelihood that the recipient will acquire the infection. Several studies reported that if HCV conversion happened, the outcomes in both heart and lung recipients were worse, even if treated with interferon/ribavirin (Haji SA, et al J Heart Lung Transplant. 2004;23:277; Wang BY, et al. Ann Thorac Surg. 2010 May;89[5]:1645; Carreno MC, et al. J Heart Lung Transplant. 2001;20(2):224). Thus, despite the shortage of thoracic organ donors and high wait-list mortality, the practice was strongly discouraged.
In 2016, the successful use of a direct-acting antiviral (DAA) for 12 weeks to eliminate HCV in a lung transplant recipient of a seropositive organ was published (Khan B, et al. Am J Transplant. 2017;17:1129). Two years later, the outcomes of seronegative heart (n=8) or lung (n=36) transplant recipients receiving organs from seropositive donors were presented (Woolley AE, et al. N Engl J Med. 2019;380:1606). Forty-two of the patients had viremia within days of the operation. All patients were treated with 4 weeks of a DAA and, of the 35 patients available for 6-month analysis, viral load was undetectable in all. Of concern, however—more cellular rejection requiring treatment was seen in the lung recipients of HCV+ donors compared with recipients of HCV- donors. The difference was not statistically significant.
The largest analysis of the safety of HCV+ donors in HCV- thoracic organ transplant recipients involved 343 heart transplant recipients (Kilic A, et al. J Am Heart Assoc. 2020;9(2):e014495). No differences were noted in outcomes, strokes, need for dialysis, or incidence of treated rejection during the first year. However, the observation regarding rejection was not subsequently confirmed by the NYU team (Gidea CG, et al. J Heart Lung Transplant. 2020;39:1199). Of 22 HCV- recipients of an HCV donor with viremia, the rate of rejection was 64% vs 18% in 28 patients receiving a donor without viremia (through day 180 (P=.001)).
In summary, the ability of DAAs to render 97%-99% of immunosuppressed transplant recipients HCV seronegative has transformed the landscape and HCV viremia in the donor (or recipient) and is no longer an absolute contraindication to transplantation. However, more information is needed as to whether there is an increased incidence of rejection.