Cardiac transplantation from non-viremic hepatitis C donors

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6 Citations (Scopus)

Abstract

BACKGROUND: Hepatitis C (HCV) donors are rarely used for cardiac transplantation due to historically poor outcomes. In 2015, nucleic acid testing (NAT) for viral load was added to the routine work-up of organ donors, allowing for the distinction between subjects who remain viremic (HCV Ab+/NAT+) and those who have cleared HCV and are no longer viremic (HCV Ab+/NAT). The American Society of Transplantation recently recommended that HCV Ab+/NAT donors be considered non-infectious and safe for transplantation. We present our initial experience with such donors. METHODS: All patients were counseled regarding donor HCV antibody (Ab) and NAT. Transplant recipients were tested post-transplant at 1 week and at 1, 3, and 6 months for HCV seropositivity and viremia. We also analyzed the UNOS database to determine the potential impact of widespread acceptance of HCV Ab+/NAT organs. RESULTS: Fourteen HCV Ab subjects received hearts from HCV Ab+/NAT donors in 2017. Over a median follow-up of 256 (192 to 377) days, 3 patients developed a reactive HCV Ab, yet none had a detectable HCV viral load during prospective monitoring at any time. Analysis of the UNOS database for the calendar year 2016 revealed that only 7 (3%) of 220 HCV Ab+/NAT donors were accepted for heart transplantation. CONCLUSIONS: We have demonstrated the feasibility of utilizing HCV Ab+/NAT donors for cardiac transplantation without recipient infection. A small percentage of recipients developed HCV Ab without evidence of viremia, possibly consistent with a biological false reactive test, as has been seen in other settings. Large-scale validation of our data may have a significant impact on transplantation rates.

Original languageEnglish (US)
JournalJournal of Heart and Lung Transplantation
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Hepatitis C Antibodies
Heart Transplantation
Hepatitis C
Nucleic Acids
Tissue Donors
Viremia
Viral Load
Transplantation
Databases
Transplants

Keywords

  • heart transplant
  • hepatitis C
  • immunsupression
  • nucleic acid testing
  • viremia

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

@article{3bbe781a265c4a11a774657085a9dcbd,
title = "Cardiac transplantation from non-viremic hepatitis C donors",
abstract = "BACKGROUND: Hepatitis C (HCV) donors are rarely used for cardiac transplantation due to historically poor outcomes. In 2015, nucleic acid testing (NAT) for viral load was added to the routine work-up of organ donors, allowing for the distinction between subjects who remain viremic (HCV Ab+/NAT+) and those who have cleared HCV and are no longer viremic (HCV Ab+/NAT–). The American Society of Transplantation recently recommended that HCV Ab+/NAT– donors be considered non-infectious and safe for transplantation. We present our initial experience with such donors. METHODS: All patients were counseled regarding donor HCV antibody (Ab) and NAT. Transplant recipients were tested post-transplant at 1 week and at 1, 3, and 6 months for HCV seropositivity and viremia. We also analyzed the UNOS database to determine the potential impact of widespread acceptance of HCV Ab+/NAT– organs. RESULTS: Fourteen HCV Ab‒ subjects received hearts from HCV Ab+/NAT– donors in 2017. Over a median follow-up of 256 (192 to 377) days, 3 patients developed a reactive HCV Ab, yet none had a detectable HCV viral load during prospective monitoring at any time. Analysis of the UNOS database for the calendar year 2016 revealed that only 7 (3{\%}) of 220 HCV Ab+/NAT– donors were accepted for heart transplantation. CONCLUSIONS: We have demonstrated the feasibility of utilizing HCV Ab+/NAT– donors for cardiac transplantation without recipient infection. A small percentage of recipients developed HCV Ab without evidence of viremia, possibly consistent with a biological false reactive test, as has been seen in other settings. Large-scale validation of our data may have a significant impact on transplantation rates.",
keywords = "heart transplant, hepatitis C, immunsupression, nucleic acid testing, viremia",
author = "Patel, {Snehal R.} and Shivank Madan and Omar Saeed and Sims, {Daniel B.} and Shin, {Jooyoung (Julia)} and Cecilia Nucci and Edward Borukhov and Goldstein, {D. Yitzchak} and Jakobleff, {William A.} and Forest, {Stephen J.} and Sasa Vukelic and Sandhya Murthy and Reinus, {John F.} and Puius, {Yoram A.} and Goldstein, {Daniel J.} and Jorde, {Ulrich P.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.healun.2018.06.012",
language = "English (US)",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",

}

TY - JOUR

T1 - Cardiac transplantation from non-viremic hepatitis C donors

AU - Patel, Snehal R.

AU - Madan, Shivank

AU - Saeed, Omar

AU - Sims, Daniel B.

AU - Shin, Jooyoung (Julia)

AU - Nucci, Cecilia

AU - Borukhov, Edward

AU - Goldstein, D. Yitzchak

AU - Jakobleff, William A.

AU - Forest, Stephen J.

AU - Vukelic, Sasa

AU - Murthy, Sandhya

AU - Reinus, John F.

AU - Puius, Yoram A.

AU - Goldstein, Daniel J.

AU - Jorde, Ulrich P.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - BACKGROUND: Hepatitis C (HCV) donors are rarely used for cardiac transplantation due to historically poor outcomes. In 2015, nucleic acid testing (NAT) for viral load was added to the routine work-up of organ donors, allowing for the distinction between subjects who remain viremic (HCV Ab+/NAT+) and those who have cleared HCV and are no longer viremic (HCV Ab+/NAT–). The American Society of Transplantation recently recommended that HCV Ab+/NAT– donors be considered non-infectious and safe for transplantation. We present our initial experience with such donors. METHODS: All patients were counseled regarding donor HCV antibody (Ab) and NAT. Transplant recipients were tested post-transplant at 1 week and at 1, 3, and 6 months for HCV seropositivity and viremia. We also analyzed the UNOS database to determine the potential impact of widespread acceptance of HCV Ab+/NAT– organs. RESULTS: Fourteen HCV Ab‒ subjects received hearts from HCV Ab+/NAT– donors in 2017. Over a median follow-up of 256 (192 to 377) days, 3 patients developed a reactive HCV Ab, yet none had a detectable HCV viral load during prospective monitoring at any time. Analysis of the UNOS database for the calendar year 2016 revealed that only 7 (3%) of 220 HCV Ab+/NAT– donors were accepted for heart transplantation. CONCLUSIONS: We have demonstrated the feasibility of utilizing HCV Ab+/NAT– donors for cardiac transplantation without recipient infection. A small percentage of recipients developed HCV Ab without evidence of viremia, possibly consistent with a biological false reactive test, as has been seen in other settings. Large-scale validation of our data may have a significant impact on transplantation rates.

AB - BACKGROUND: Hepatitis C (HCV) donors are rarely used for cardiac transplantation due to historically poor outcomes. In 2015, nucleic acid testing (NAT) for viral load was added to the routine work-up of organ donors, allowing for the distinction between subjects who remain viremic (HCV Ab+/NAT+) and those who have cleared HCV and are no longer viremic (HCV Ab+/NAT–). The American Society of Transplantation recently recommended that HCV Ab+/NAT– donors be considered non-infectious and safe for transplantation. We present our initial experience with such donors. METHODS: All patients were counseled regarding donor HCV antibody (Ab) and NAT. Transplant recipients were tested post-transplant at 1 week and at 1, 3, and 6 months for HCV seropositivity and viremia. We also analyzed the UNOS database to determine the potential impact of widespread acceptance of HCV Ab+/NAT– organs. RESULTS: Fourteen HCV Ab‒ subjects received hearts from HCV Ab+/NAT– donors in 2017. Over a median follow-up of 256 (192 to 377) days, 3 patients developed a reactive HCV Ab, yet none had a detectable HCV viral load during prospective monitoring at any time. Analysis of the UNOS database for the calendar year 2016 revealed that only 7 (3%) of 220 HCV Ab+/NAT– donors were accepted for heart transplantation. CONCLUSIONS: We have demonstrated the feasibility of utilizing HCV Ab+/NAT– donors for cardiac transplantation without recipient infection. A small percentage of recipients developed HCV Ab without evidence of viremia, possibly consistent with a biological false reactive test, as has been seen in other settings. Large-scale validation of our data may have a significant impact on transplantation rates.

KW - heart transplant

KW - hepatitis C

KW - immunsupression

KW - nucleic acid testing

KW - viremia

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U2 - 10.1016/j.healun.2018.06.012

DO - 10.1016/j.healun.2018.06.012

M3 - Article

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

ER -