1
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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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2
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McCain JD, Chascsa DM. Special Considerations in the Management of HIV and Viral Hepatitis Coinfections in Liver Transplantation. Hepat Med 2022; 14:27-36. [PMID: 35514530 PMCID: PMC9063796 DOI: 10.2147/hmer.s282662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/07/2022] [Indexed: 11/26/2022] Open
Abstract
Modern therapies for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus have become so effective that patients treated for these conditions can have normal life-expectancies. Suitable livers for transplantation remain a scarce and valuable resource. As such, significant efforts have been made to expand donation criteria at many centers. This constant pressure, coupled with the increasing effectiveness of antiviral therapies, has meant that more and more patients infected with hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) may be considered appropriate donors in the right circumstances. Patients with these infections are also more likely to be considered appropriate transplantation recipients than in the past. The treatment of HBV, HCV, and HIV after liver transplantation (LT) can be challenging and complicated by viral coinfections. The various pharmaceutical agents used to treat these infections, as well as the immunosuppressants used post-LT must be carefully balanced for maximum efficacy, and to avoid resistance and drug–drug interactions.
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Affiliation(s)
- Josiah D McCain
- Department of Gastroenterology & Hepatology, Mayo Clinic, Phoenix, AZ, USA
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3
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Abstract
BACKGROUND The effect of hepatitis C virus (HCV) infection in recipients or donors on heart transplants is less known in the current era after the introduction of direct-acting antiviral agents (DAAs) in 2011. METHODS Using the United Network for Organ Sharing registry, 24 871 adult heart transplant recipients between 2005 and 2019 were identified. The trend in prevalence of HCV infected recipients and in utilization of HCV infected donors and their effect on the transplant outcomes were investigated in the past era versus the current era separated by 2011, using Cox proportional hazard regression. RESULTS HCV antibody positive recipients (n=520, 2.1%) had stable prevalence (P=0.18). They had a lower survival estimate when compared to HCV antibody negative recipients in the past era (55.3% versus 70.9% at 7 years; hazard ratio (HR), 1.56; 95% confidence interval (CI), 1.27-1.91; P<0.001), however not in the current era (73.1% versus 71.5% at 7 years; HR, 1.00; 95% CI, 0.75-1.32; P=0.98) (Pinteraction<0.001). Organ use from HCV antibody positive donors (n=371, 1.5%) was concentrated in the recent years (P<0.001) and provided the similar survival estimate up to 2 years (84.2% versus 87.6%; HR, 0.97; 95% CI, 0.65-1.44; P=0.87). The similar findings were confirmed with a subgroup cohort with positive nucleic acid amplification test (NAT). CONCLUSIONS Positive HCV antibody in recipients did not adversely affect the long-term transplant outcomes in the current era. Graft utilization from positive HCV antibody or NAT positive donors are rapidly more prevalent and appeared to be promising up to 2 years posttransplant.
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4
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Liu CH, Chen YS, Wang SS, Liu CJ, Su TH, Yang HC, Hong CM, Chen PJ, Chen DS, Kao JH. Sofosbuvir-based Interferon-Free Direct Acting Antiviral Regimens for Heart Transplant Recipients With Chronic Hepatitis C Virus Infection. Clin Infect Dis 2019; 66:289-292. [PMID: 29020359 DOI: 10.1093/cid/cix787] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 08/30/2017] [Indexed: 12/14/2022] Open
Abstract
We assessed the effectiveness and safety of sofosbuvir (SOF) combined with ledipasvir (LDV) or daclatasvir (DCV) in 12 heart transplant recipients with chronic hepatitis C virus (HCV). The sustained virologic response (SVR12) rate was 100% [95% confidence interval [CI]: 75.8%-100%]. All patients tolerated treatment well without interruption, death, or serious adverse events.
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Affiliation(s)
- Chen-Hua Liu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei.,Hepatitis Research Center, National Taiwan University Hospital, Taipei.,Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Douliou
| | - Yih-Sharng Chen
- Department of Surgery, National Taiwan University Hospital, Taipei
| | - Sheoi-Shen Wang
- Department of Surgery, National Taiwan University Hospital, Taipei.,Department of Surgery, Fu Jen Catholic University Hospital, New Taipei City, Taiwan.,Fu Jen Catholic University College of Medicine, New Taipei City, Taiwan
| | - Chun-Jen Liu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei.,Hepatitis Research Center, National Taiwan University Hospital, Taipei.,Graduate Institute of Clinical Medicine, National Taiwan University Hospital, Taipei
| | - Tung-Hung Su
- Department of Internal Medicine, National Taiwan University Hospital, Taipei.,Hepatitis Research Center, National Taiwan University Hospital, Taipei
| | - Hung-Chih Yang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei.,Hepatitis Research Center, National Taiwan University Hospital, Taipei.,Department of Microbiology, National Taiwan University Hospital, Taipei
| | - Chun-Ming Hong
- Department of Traumatology, National Taiwan University Hospital, Taipei
| | - Pei-Jer Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei.,Hepatitis Research Center, National Taiwan University Hospital, Taipei.,Graduate Institute of Clinical Medicine, National Taiwan University Hospital, Taipei
| | - Ding-Shinn Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei.,Hepatitis Research Center, National Taiwan University Hospital, Taipei.,Graduate Institute of Clinical Medicine, National Taiwan University Hospital, Taipei.,Genomics Research Center, Academia Sinica, Taipei
| | - Jia-Horng Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei.,Hepatitis Research Center, National Taiwan University Hospital, Taipei.,Graduate Institute of Clinical Medicine, National Taiwan University Hospital, Taipei
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5
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Bruno S, Nicole B, Nila J D, Gail M, James N, Peter S M, Christopher S H. Heart Transplantation From Hepatitis C-Positive Donors in the Era of Direct Acting Antiviral Therapy: A Comprehensive Literature Review. Transplant Direct 2019; 5:e486. [PMID: 31579814 PMCID: PMC6739042 DOI: 10.1097/txd.0000000000000928] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 02/06/2023] Open
Abstract
While heart transplantation is a highly effective treatment in patients with advanced heart failure, the number of people waiting for a transplant exceeds the number of available donors. With the advent of direct acting antivirals (DAA) for the eradication of Hepatitis C, the heart transplant donor pool has been expanded to include donors with untreated Hepatitis C. To help with the development of future protocols for Hepatitis C-positive heart transplants, we performed a review of the literature on DAA therapy in the context of heart transplantation. METHODS We searched MEDLINE, EMBASE, OVIDE JOURNAL, and GOOGLE SCHOLAR for papers published between 01.01.2011 and 01.06.2019 using key words "heart transplantation" associated with "hepatitis C." RESULTS After removing duplicates, we screened 78 articles and retained 16 for primary analysis and 20 for sustained virologic response 12 weeks after completion of the DAA therapy (SVR-12). The data from 62 patients were extracted from these publications. Fifty-six (90%) patients had donor-derived hepatitis C and 6 (10%) patients were chronically infected with hepatitis C before transplantation. All living transplanted patients achieved SVR-12, defined as hepatitis C virus RNA below the limit of detection 12 weeks after treatment completion. Treatment duration ranged from 4 to 24 weeks. Clinically relevant modification to the dosing of immunosuppressive mediations during DAA therapy was documented in only 1 patient (1.6%). Six (14%) patients experienced rejection during DAA therapy. CONCLUSIONS Despite different timings of initiation of DAA therapy across the included studies, there were no differences in sustained viral clearance. Early commencement of DAA with a potentially shorter treatment duration (<8 wk) is appealing; however, further studies are required before recommending this approach.
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Affiliation(s)
- Schnegg Bruno
- Department of Cardiology, Center for advance heart failure, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Heart and Lung Transplant Unit, St Vincent's Hospital, 390 Victoria St., Darlinghurst, NSW, Australia
| | - Bart Nicole
- Heart and Lung Transplant Unit, St Vincent's Hospital, 390 Victoria St., Darlinghurst, NSW, Australia
| | - Dharan Nila J
- HIV, Immunology and Infectious Disease Unit, St Vincent's Hospital, 390 Victoria St., Darlinghurst, NSW, Australia
| | - Matthews Gail
- HIV, Immunology and Infectious Disease Unit, St Vincent's Hospital, 390 Victoria St., Darlinghurst, NSW, Australia
| | - Nadel James
- Heart and Lung Transplant Unit, St Vincent's Hospital, 390 Victoria St., Darlinghurst, NSW, Australia
| | - Macdonald Peter S
- Heart and Lung Transplant Unit, St Vincent's Hospital, 390 Victoria St., Darlinghurst, NSW, Australia
| | - Hayward Christopher S
- Heart and Lung Transplant Unit, St Vincent's Hospital, 390 Victoria St., Darlinghurst, NSW, Australia
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6
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Sise ME, Strohbehn IA, Bethea E, Gustafson JL, Chung RT. Balancing the risk and rewards of utilizing organs from hepatitis C viremic donors. Curr Opin Organ Transplant 2019; 24:351-357. [PMID: 31090648 PMCID: PMC7093034 DOI: 10.1097/mot.0000000000000651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Owing to long waitlist times and high waitlist morbidity and mortality, strategies to increase utilization of hepatitis C viremic-deceased donor organs are under investigation in kidney, liver, heart, and lung transplantation. RECENT FINDINGS Direct-acting antiviral medications for hepatitis C virus infection have high cure rates and are well tolerated. Small, single-center trials in kidney and heart transplant recipients have demonstrated that with early posttransplant direct-acting antiviral therapy, 100% of uninfected recipients of hepatitis C viremic organs have been cured of infection after transplantation. SUMMARY In this manuscript, we review the risks and rewards of utilizing hepatitis C viremic organs for transplantation.
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Affiliation(s)
- Meghan E. Sise
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital
| | - Ian A. Strohbehn
- Department of Medicine, Liver Center, Gastrointestinal Division, Massachusetts General Hospital
| | - Emily Bethea
- Department of Medicine, Liver Center, Gastrointestinal Division, Massachusetts General Hospital
| | - Jenna L. Gustafson
- Department of Medicine, Liver Center, Gastrointestinal Division, Massachusetts General Hospital
| | - Raymond T. Chung
- Department of Medicine, Liver Center, Gastrointestinal Division, Massachusetts General Hospital
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7
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Khosravi A, Karimi-Sari H, Abedi-Andani M, Behnava B, Namvar A, Anvar A, Alavian SM. Acute changes in cardiac function by direct acting antiviral therapy for hepatitis C-infected patients with thalassemia. J Med Virol 2018; 91:419-427. [PMID: 30204230 DOI: 10.1002/jmv.25314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/04/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients with thalassemia may also have cardiac abnormalities due to congenital problems, anemia, and increased burden of iron in their myocardium. This study was designed to evaluate the effects of direct acting antiviral (DAA) therapy on the cardiac function of hepatitis C virus (HCV)-infected patients with thalassemia. METHOD HCV-infected thalassemia patients were enrolled to this prospective evaluation. Daily tablets of 90 mg Ledipasvir (or 60 mg Daclatasvir) plus 400 mg Sofosbuvir (±ribavirin) were prescribed for the patients according to the Iran Hepatitis Network's guidelines. An echocardiography fellow collected the echocardiography findings before and after the treatment of all the patients. The patients were followed up for any cardiac events within 12 weeks after finishing the treatment. RESULTS Thirty-two patients with the mean age of 24.2 ± 6.4 years were evaluated. All patients showed a sustained virological response at the 12th week after finishing the treatment. The patients' left ventricular end systolic diameter (3.0 vs 3.24; P = 0.003) and volume (33.8 vs 43.6; P = 0.001), global longitudinal strain of the left ventricle (-22.0 vs -20.6, P = 0.046), and average (-21.4 vs -20.3; P = 0.048), and the right ventricle size (3.12 vs 3.31; P = 0.012) were significantly increased after finishing the treatment. Changes in the abovementioned parameters were not correlated with the patients' myocardium iron load. There were no significant differences in other echocardiographic parameters ( P > 0.05) before and after the treatment. CONCLUSION Sofosbuvir-based regimens for HCV treatment were safe for our HCV-infected patients with thalassemia. Our patients' ejection fraction remained unchanged. Hence, more specialized echocardiographic evaluations were recommended for those with a history of cardiac abnormalities, cardiac iron overload, and in case of any cardiac adverse event during DAA therapy in patients with thalassemia.
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Affiliation(s)
- Arezoo Khosravi
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran.,Middle East Liver Diseases (MELD) Center, Tehran, Iran.,Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hamidreza Karimi-Sari
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran.,Middle East Liver Diseases (MELD) Center, Tehran, Iran.,Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mahdi Abedi-Andani
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran.,Middle East Liver Diseases (MELD) Center, Tehran, Iran.,Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Bita Behnava
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran.,Middle East Liver Diseases (MELD) Center, Tehran, Iran
| | - Ali Namvar
- Iranian Comprehensive Hemophilia Care Center, Tehran, Iran
| | - Ali Anvar
- Iranian Comprehensive Hemophilia Care Center, Tehran, Iran
| | - Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran.,Middle East Liver Diseases (MELD) Center, Tehran, Iran
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8
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Mansour M, Hill L, Kerr J. Safety and effectiveness of direct acting antivirals for treatment of hepatitis C virus in patients with solid organ transplantation. Transpl Infect Dis 2018; 20:e12972. [PMID: 30080955 DOI: 10.1111/tid.12972] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/22/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The direct acting antivirals (DAAs) for treatment of hepatitis C virus (HCV) infection have sustained virologic response (SVR) rates of greater than 90% in most patients. However, data evaluating DAA use in transplant patients are limited. The goal of this study was to evaluate the effectiveness and safety of HCV treatment in this high-risk population. METHODOLOGY This single-center retrospective study included liver, kidney, lung, and/or heart transplant patients who were treated for HCV infection with DAAs. The primary objective was to identify drug-drug interactions between DAAs and immunosuppressants by comparing immunosuppression dosages and levels at baseline and week 4 of HCV treatment. As secondary objectives, we described the percentage of patients with new or worsening rejection and/or graft dysfunction during HCV treatment, and the percentage of study patients who achieved SVR. RESULTS Of the 108 patients included, the majority had liver (76%) or kidney (13%) transplants. Simeprevir plus sofosbuvir was the most commonly prescribed HCV treatment (33.9%) and tacrolimus was the most common immunosuppressant (91%). We did not detect a statistically significant difference in immunosuppression dosages or levels during HCV treatment. Furthermore, only one patient (<1%) experienced rejection and five patients (4.6%) had six episodes of graft dysfunction while on DAAs. Efficacy was high with 98% of patients achieving SVR. CONCLUSION DAAs appear to be safe and effective for HCV treatment in patients with a history of liver and/or kidney transplantation. More data are needed to evaluate DAAs in lung and/or heart transplant patients.
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Affiliation(s)
- Marlina Mansour
- Department of Pharmacy Services, UC San Diego Health, La Jolla, California
| | - Lucas Hill
- Department of Hepatology, UC San Diego Health, San Diego, California
| | - Janice Kerr
- Abdominal Transplantation, UC San Diego Health, La Jolla, California
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9
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Medeiros T, Rosário NF, Saraiva GN, Andrade TG, Silva AA, Almeida JR. Renal safety after one year of sofosbuvir-based therapy for chronic hepatitis C: A Brazilian "real-life" study. J Clin Pharm Ther 2018; 43:707-713. [PMID: 29737025 DOI: 10.1111/jcpt.12697] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/28/2018] [Indexed: 01/12/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Sofosbuvir(SOF)-based regimens have been administrated with excellent efficacy in chronic hepatitis C. Few uncontrolled ("real-life") studies consider the assessment of renal function when evaluating their post-treatment outcomes. This study aims to evaluate renal biomarkers in a "real-life" experience with chronic hepatitis C patients treated with SOF therapy in a long-term follow-up. METHODS Serum and urinary biomarkers were analysed before, at the end of therapy (EoT), after 12 weeks (sustained virological response-SVR) and one year (1y) post-treatment. Patients were categorized according to baseline glomerular filtration rate (GFR-cut-off 45 mL/min/1.73 m2 ). RESULTS Ninety-four patients with a mean age of 59.9 ± 8.5 years were included; 98.9% of patients reached SVR. Significant improvement in renal biomarkers was observed in patients with GFR ≥45 mL/min/1.73 m2 , as indicated by a progressive increase in mean GFR values until 1y. No evidence of tubular dysfunction was identified. Patients with baseline GFR <45 mL/min/1.73 m2 did not experience alterations in renal biomarkers; however, a mean change of +10.7 in GFR values was observed. We noticed significant upper stage transition in the CKD classification, and 58.7% of patients achieved G1 stage at 1y (P < .0001). WHAT IS NEW AND CONCLUSION In a "real-life experience" of a Brazilian centre, SOF therapy appears to guarantee renal safety for patients with chronic hepatitis C followed until one year after treatment.
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Affiliation(s)
- T Medeiros
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Brazil
| | - N F Rosário
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Brazil
| | - G N Saraiva
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Brazil
| | - T G Andrade
- Centro de Referência de Tratamento em Hepatites/HUAP, Serviço de Gastroenterologia, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Brazil
| | - A A Silva
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Brazil.,Departamento de Patologia, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Brazil
| | - J R Almeida
- Laboratório Multiusuário de Apoio à Pesquisa em Nefrologia e Ciências Médicas, Departamento de Medicina Clínica, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Brazil
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10
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Shafii AE, Harris DD, Baz M. Clearance of Hepatitis C Virus Prior to Lung Transplantation: A Case Report. Transplant Proc 2018; 49:1682-1684. [PMID: 28838464 DOI: 10.1016/j.transproceed.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 06/16/2017] [Indexed: 02/07/2023]
Abstract
Hepatitis C virus (HCV) continues to be considered a relative contraindication to lung transplantation due to concerns of progression of liver disease with the introduction of immunosuppression. Since the recent introduction of effective antiviral therapy for HCV, new approaches in the management of the HCV-positive recipient are being utilized in liver transplantation to clear HCV pre- and post-transplant. Herein, we report use of ledipasvir/sofosbuvir for HCV clearance prior to lung transplantation in a patient with usual interstitial pneumonia. Listing for transplant was delayed until completion of HCV treatment, and he subsequently required extracorporeal membrane oxygenation as a bridge to transplantation due to progressive hypoxia. With antiviral cure rates exceeding 90%, HCV should no longer be considered a relative contraindication to lung transplant, and timing of antiviral treatment should consider the progressive nature of the recipient's lung disease.
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Affiliation(s)
- A E Shafii
- Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky, USA.
| | - D D Harris
- University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - M Baz
- Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky, USA
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11
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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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12
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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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13
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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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