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Nunez M, Kelkar AA. Hepatitis C and heart transplantation: An update. Clin Transplant 2023; 37:e15111. [PMID: 37650430 DOI: 10.1111/ctr.15111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023]
Abstract
There are limited data regarding heart transplantation in the setting of hepatitis C virus (HCV) infection in either recipients or donors, as the practice was infrequent, given concerns of worse post-transplant outcomes. This changed dramatically after the development of highly effective HCV therapies, namely direct-acting antivirals (DAAs). Additionally, nucleic acid testing currently in use establishes more precisely the risk of HCV transmission from donors. As a result, chronic HCV infection in itself is no longer a barrier for heart transplant candidates, and the use of HCV-positive organs for HCV-infected and non-infected transplant candidates has increased dramatically. A review of the literature revealed that in the pre-DAA era, HCV seropositive heart transplant patients had a higher mortality than their seronegative counterparts. However, short-term data suggest that the differences in survival have been erased in the DAA era. Heart transplantation from HCV-viremic donors to HCV-uninfected recipients has become increasingly common as the number of deceased donors with HCV viremia has increased over the past years. Preliminary outcome reports are very encouraging, although further data are needed with regard to long-term safety. New information continues to be incorporated to optimize protocols that guide this practice.
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Affiliation(s)
- Marina Nunez
- Department of Internal Medicine, Section on Infectious Diseases, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, North Carolina, USA
| | - Anita A Kelkar
- U.S. Department of Veterans Affairs, Kernersville VA Health Care System, Kernesville, North Carolina, USA
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Somerville L, Doucette K. Hepatitis C: Current Controversies and Future Potential in Solid Organ Transplantation. Curr Infect Dis Rep 2018; 20:18. [PMID: 29789956 DOI: 10.1007/s11908-018-0625-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW To highlight the changing landscape of hepatitis C virus (HCV) infection in the context of organ transplantation. This focuses on areas of controversy and future potential in the era of highly effective direct-acting antiviral (DAA) agents. RECENT FINDINGS Since the advent of safe and highly effective DAA therapy, HCV infection is now curable in virtually all cases, including organ transplant recipients. Excellent drug tolerability and safety combined with high cure rates across all organ groups means that HCV is no longer a barrier to transplantation or its outcomes. Mounting data demonstrate the safety of using organs from HCV-infected donors with subsequent treatment of HCV in the recipient and a potential to expand the donor pool. Historical data demonstrating inferior survival in transplant recipients with HCV is of limited relevance in the DAA era. Virtually all transplant recipients with HCV infection can be cured, while early data also suggest excellent outcomes in recipients of organs from HCV viremic donors. The optimal timing of HCV therapy in relation to transplantation and the optimal use of organs from HCV viremic donors remain areas of controversy and ongoing research efforts.
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Affiliation(s)
- Lucy Somerville
- Department of Medicine, Division of Infectious Diseases, University of Alberta, CSB 1-139, 11350 83 Avenue, Edmonton, AB, T6G 2G3, Canada
| | - Karen Doucette
- Department of Medicine, Division of Infectious Diseases, University of Alberta, CSB 1-139, 11350 83 Avenue, Edmonton, AB, T6G 2G3, Canada.
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Vitrone M, Andini R, Mattucci I, Maiello C, Atripaldi L, Durante-Mangoni E, Zampino R. Direct antiviral treatment of chronic hepatitis C in heart transplant recipients. Transpl Infect Dis 2017; 20. [PMID: 29139181 DOI: 10.1111/tid.12813] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/19/2017] [Accepted: 08/29/2017] [Indexed: 12/17/2022]
Abstract
Direct-acting antiviral agents (DAAs) are a safe and effective treatment for chronic hepatitis C (CHC). This may be particularly valuable for patients with severe comorbidities or baseline conditions, including non-liver solid organ transplant. We report cases of two heart transplant recipients with CHC treated with DAAs (sofosbuvir and daclatasvir) achieving sustained virological response. Treatment was well tolerated and no relevant side effects were observed. The drug-drug interactions and graft function were carefully monitored.
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Affiliation(s)
- Martina Vitrone
- Internal Medicine, University of Campania 'L. Vanvitelli', Napoli, Italy
| | - Roberto Andini
- Internal Medicine, University of Campania 'L. Vanvitelli', Napoli, Italy
| | - Irene Mattucci
- Internal Medicine, University of Campania 'L. Vanvitelli', Napoli, Italy.,Transplant Surgery, AORN Ospedali dei Colli, Ospedale Monaldi, Napoli, Italy
| | - Ciro Maiello
- Transplant Surgery, AORN Ospedali dei Colli, Ospedale Monaldi, Napoli, Italy
| | - Luigi Atripaldi
- Clinical Biochemistry, AORN Ospedali dei Colli, Ospedale Monaldi, Napoli, Italy
| | - Emanuele Durante-Mangoni
- Internal Medicine, University of Campania 'L. Vanvitelli', Napoli, Italy.,Infectious and Transplant Medicine, AORN Ospedali dei Colli, Ospedale Monaldi, Napoli, Italy
| | - Rosa Zampino
- Internal Medicine, University of Campania 'L. Vanvitelli', Napoli, Italy.,Infectious and Transplant Medicine, AORN Ospedali dei Colli, Ospedale Monaldi, Napoli, Italy
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Stepanova M, Locklear T, Rafiq N, Mishra A, Venkatesan C, Younossi ZM. Long-term outcomes of heart transplant recipients with hepatitis C positivity: the data from the U.S. transplant registry. Clin Transplant 2016; 30:1570-1577. [DOI: 10.1111/ctr.12859] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Maria Stepanova
- Betty and Guy Beatty Center for Integrated Research; Inova Health System; Falls Church VA USA
- Center for Outcomes Research in Liver Diseases; Washington DC USA
| | - Trevor Locklear
- Department of Medicine; Center for Liver Diseases; Inova Fairfax Hospital; Falls Church VA USA
| | - Nila Rafiq
- Betty and Guy Beatty Center for Integrated Research; Inova Health System; Falls Church VA USA
- Department of Medicine; Center for Liver Diseases; Inova Fairfax Hospital; Falls Church VA USA
| | - Alita Mishra
- Betty and Guy Beatty Center for Integrated Research; Inova Health System; Falls Church VA USA
- Department of Medicine; Center for Liver Diseases; Inova Fairfax Hospital; Falls Church VA USA
| | - Chapy Venkatesan
- Department of Medicine; Center for Liver Diseases; Inova Fairfax Hospital; Falls Church VA USA
| | - Zobair M. Younossi
- Betty and Guy Beatty Center for Integrated Research; Inova Health System; Falls Church VA USA
- Department of Medicine; Center for Liver Diseases; Inova Fairfax Hospital; Falls Church VA USA
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Kumar S, Deo SV, Altarabsheh SE, Dunlay SM, Sarabu N, Sareyyupoglu B, Elgudin Y, Medalion B, ElAmm C, Ginwalla M, Zacharias M, Benatti R, Oliveira GH, Kilic A, Fonarow GC, Park SJ. Effect of Hepatitis C Positivity on Survival in Adult Patients Undergoing Heart Transplantation (from the United Network for Organ Sharing Database). Am J Cardiol 2016; 118:132-7. [PMID: 27189814 DOI: 10.1016/j.amjcard.2016.04.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/13/2016] [Accepted: 04/13/2016] [Indexed: 02/07/2023]
Abstract
Concerns exist regarding orthotropic heart transplantation in hepatitis C virus (HCV) seropositive recipients. Thus, a national registry was accessed to evaluate early and late outcome in HCV seropositive recipients undergoing heart transplant. Retrospective analysis of the United Network for Organ Sharing registry (1991 to 2014) was performed to evaluate recipient profile and clinical outcome of patients with HCV seropositive (HCV +ve) and seronegative (HCV -ve). Adjusted results of early mortality and late survival were compared between cohorts. From 23,507 patients (mean age 52 years; 75% men), 481 (2%) were HCV +ve (mean age 52 years; 77% men). Annual proportion of HCV +ve recipients was comparable over the study period (range 1.3% to 2.7%; p = 0.2). The HCV +ve cohort had more African-American (22% vs 17%; p = 0.01), previous left ventricular assist device utilization (21% vs 14%; p <0.01) and more hepatitis B core Ag+ve recipients (17% vs 5%; p <0.01). However, both cohorts were comparable in terms of extracorporeal membrane oxygenator usage (p = 0.7), inotropic support (p = 0.2), intraaortic balloon pump (p = 0.7) support, serum creatinine (p = 0.7), and serum bilirubin (p = 0.7). Proportion of status 1A patients was similar (24% HCV + vs 21% HCV -); however, wait time for HCV +ve recipients were longer (mean 23 vs 19 days; p <0.01). Among donor variables, age (p = 0.8), hepatitis B status (p = 0.4), and Center for Diseases Control high-risk status (p = 0.9) were comparable in both cohorts. At a median follow-up of 4 years, 67% patients were alive, 28% died, and 1.1% were retransplanted (3.4% missing). Overall survival was worse in the HCV+ cohort (64.3% vs 72.9% and 43.2% vs 55% at 5 and 10 years; p <0.01), respectively. Late renal (odds ratio [OR] 1.2 [1 to 1.6]; p = 0.02) and liver dysfunction (odds ratio 4.5 [1.2 to 15.7]; p = 0.01) occurs more frequently in HCV +ve recipients. On adjusted analysis, HCV seropositivity is associated with poorer survival (hazard ratio for mortality 1.4 [1.1 to 1.6]; p <0.001). In conclusion, a small proportion of patients receiving a heart transplant in the United States have hepatitis C. Despite comparable preoperative hepatic function, hepatitis C seropositive recipients demonstrate poorer long-term survival.
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Affiliation(s)
- Sachin Kumar
- Division of Cardiovascular Surgery, Advanced Heart Failure Program, University of Texas Medical Center, Houston, Texas
| | - Salil V Deo
- Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio.
| | - Salah E Altarabsheh
- Department of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan
| | | | - Nagaraju Sarabu
- Division of Nephrology and Renal Transplantation, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Basar Sareyyupoglu
- Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Yakov Elgudin
- Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Benjamin Medalion
- Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Chantal ElAmm
- Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Mahazarin Ginwalla
- Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Michael Zacharias
- Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Rodolpho Benatti
- Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Guilherme H Oliveira
- Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Ahmet Kilic
- Division of Cardiothoracic Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Gregg C Fonarow
- Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, Los Angeles, California
| | - Soon J Park
- Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio
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Belga S, Doucette KE. Hepatitis C in non-hepatic solid organ transplant candidates and recipients: A new horizon. World J Gastroenterol 2016; 22:1650-63. [PMID: 26819530 PMCID: PMC4721996 DOI: 10.3748/wjg.v22.i4.1650] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/20/2015] [Accepted: 11/24/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) infection is estimated to affect 130-150 million people globally which corresponds to 2%-3% of the total world population. It remains the leading indication for liver transplant worldwide and has been demonstrated to negatively impact both patient and graft survival following non-hepatic organ transplantation. In the era of interferon-based therapy, although treatment and cure of HCV prior to non-hepatic transplant improved survival, tolerability and low cure rates substantially limited therapy. Interferon (IFN)-based therapy following non-hepatic solid organ transplant, due to the risk of allograft rejection, is generally contraindicated. Rapid advances in IFN-free therapy with direct acting antivirals (DAAs) in the last few years have completely changed the paradigm of hepatitis C therapy. Compared to IFN-based regimens, DAAs have less frequent and less severe adverse effects, shorter durations of therapy, and higher cure rates that are minimally impacted by historically negative predictors of response such as cirrhosis, ethnicity, and post-transplant state. Recent studies have shown that liver transplant (LT) recipients can be safely and effectively treated with DAA combination therapies; although data are limited, many of the principles of therapy in LT may be extrapolated to non-hepatic solid organ transplant recipients. Here we review the data on DAA combination therapies in transplantation, discuss the advantages and disadvantages of pre- vs post-transplant HCV therapy and future directions.
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