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Schulz P, Wiginton A, Mahgoub A. Newly diagnosed hepatitis C infection after pancreas transplantation with multiple treatment failures. BMJ Case Rep 2023; 16:e254331. [PMID: 37137548 PMCID: PMC10163427 DOI: 10.1136/bcr-2022-254331] [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] [Indexed: 05/05/2023] Open
Abstract
This case represents the first report of a detected hepatitis C virus (HCV) infection following a pancreas transplantation that failed two different sofosbuvir (SOF)-based treatments. We present the case of a woman in her 30s with a history of kidney transplantation, who developed viremic symptoms 3 months after pancreas transplantation and with two subsequent negative HCV antibody tests. Further work-up revealed a positive HCV RNA test (genotype 1A, treatment naive). Two different direct-acting antiviral agents regimes with SOF failed in our case, and the patient achieved a sustained virological response with a 16-week course of glecaprevir/pibrentasvir.
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Affiliation(s)
- Philipp Schulz
- Internal Medicine, Texas Tech University Health Sciences Center School of Medicine Permian Basin, Odessa, Texas, USA
| | - Ashley Wiginton
- Transplant Hepatology and Gastroenterology, Baylor University Medical Center, Dallas, Texas, USA
| | - Amar Mahgoub
- Transplant Hepatology and Gastroenterology, Baylor University Medical Center, Dallas, Texas, USA
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2
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Chang SH, Chan J, Patterson GA. History of Lung Transplantation. Clin Chest Med 2023; 44:1-13. [PMID: 36774157 DOI: 10.1016/j.ccm.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Lung transplantation remains the only available therapy for many patients with end-stage lung disease. The number of lung transplants performed has increased significantly, but development of the field was slow compared with other solid-organ transplants. This delayed growth was secondary to the increased complexity of transplanting lungs; the continuous needs for surgical, anesthetics, and critical care improvements; changes in immunosuppression and infection prophylaxis; and donor management and patient selection. The future of lung transplant remains promising: expansion of donor after cardiac death donors, improved outcomes, new immunosuppressants targeted to cellular and antibody-mediated rejection, and use of xenotransplantation or artificial lungs.
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Affiliation(s)
- Stephanie H Chang
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York University Langone Health, New York City, NY, USA.
| | - Justin Chan
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York University Langone Health, New York City, NY, USA
| | - G Alexander Patterson
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
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3
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Sawinski D, Rosenblatt RE, Morales JM. Renal transplantation using kidneys from hepatitis C-infected donors: A review of 30-years' experience. Nefrologia 2022:S2013-2514(22)00178-X. [PMID: 36564226 DOI: 10.1016/j.nefroe.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/18/2022] [Indexed: 06/17/2023] Open
Abstract
Kidney transplantation is the optimal therapy for end-stage kidney disease but limited by the available number of organs. Using HCV+ donors, both in HCV+ and HCV- recipients, is a rational response to the organ shortage. We review the historic experience using HCV+ donors in HCV+ recipients and assess long-term results. We also discuss contemporary practices, including the transplantation of HCV-viremic kidneys into HCV- recipients with different approaches to posttransplant HCV therapy.
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Affiliation(s)
- Deirdre Sawinski
- Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Russel E Rosenblatt
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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4
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Patel P, Patel N, Ahmed F, Gluck J. Review of heart transplantation from hepatitis C-positive donors. World J Transplant 2022; 12:394-404. [PMID: 36570408 PMCID: PMC9782687 DOI: 10.5500/wjt.v12.i12.394] [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: 09/09/2022] [Revised: 11/03/2022] [Accepted: 11/22/2022] [Indexed: 12/16/2022] Open
Abstract
Significant scarcity of a donor pool exists for heart transplantation (HT) as the prevalence of patients with end-stage refractory heart failure is increasing exceptionally. With the discovery of effective direct-acting antiviral and favorable short-term outcomes following HT, the hearts from hepatitis C virus (HCV) patient are being utilized to increase the donor pool. Short-term outcomes with regards to graft function, coronary artery vasculopathy, and kidney and liver disease is comparable in HCV-negative recipients undergoing HT from HCV-positive donors compared to HCV-negative donors. A significant high incidence of donor-derived HCV transmission was observed with great success of achieving sustained viral response with the use of direct-acting antivirals. By accepting HCV-positive organs, the donor pool has expanded with younger donors, a shorter waitlist time, and a reduction in waitlist mortality. However, the long-term outcomes and impact of specific HCV genotypes remains to be seen. We reviewed the current literature on HT from HCV-positive donors.
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Affiliation(s)
- Palak Patel
- Department of Cardiology, West Roxbury VA Center, West Roxbury, MA 02132, United States
| | - Nirav Patel
- Department of Cardiology, University of Connecticut, Harford Hospital, Hartford, CT 06102, United States
- Department of Cardiology, University of California, CA 90065, United States
| | - Fahad Ahmed
- Department of Internal Medicine, Hartford Hospital, Hartford, CT 06106, United States
| | - Jason Gluck
- Advanced Heart Failure, Hartford Hospital, Hartford, CT 06102, United States
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Shadekejiang H, Zhu J, Wu X. Transplant of Kidneys From Hepatitis C Virus-Positive Donors To Hepatitis C Virus-Negative Recipients: A Retrospective Study and Systematic Review. EXP CLIN TRANSPLANT 2022; 20:1076-1084. [PMID: 36718006 DOI: 10.6002/ect.2022.0315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Kidneys from hepatitis C virus-positive donors were often discarded due to the lack of an effective treatment for hepatitis C virus. However, the advent of direct-acting antivirals has facilitated great progress for treatment of hepatitis C virus, providing additional opportunities for patients waiting for kidney transplant. We explored the feasibility and safety of kidney transplant from hepatitis C virus- positive donors to hepatitis C virus-negative recipients in combination with direct-acting antiviral therapy. MATERIALS AND METHODS This was a single-center retrospective study of 7 recipients of hepatitis C virus- positive kidneys from June 2018 to June 2021. All recipients were treated with sofosbuvir/velpatasvir for 12 weeks after kidney transplant. The primary recipients' outcome was achievement of sustained viral eradication at 12 weeks after treatment, and follow-up secondary outcomes were kidney function recovery, liver function, and adverse drug reactions. We reviewed previous studies, from 2017 to 2022, to analyze achievement of sustained viral eradication at 12 weeks after treatment, recipient and graft survival, and adverse event of kidney transplant from a hepatitis C virus-positive donor to a hepatitis C virus-negative recipient. RESULTS Median follow-up time was 71 weeks (range, 56-183 weeks). All recipients achieved sustained viral eradication at 12 weeks after treatment, and their kidney function recovered without severe liver damage or adverse drug reactions. Previous studies suggested that transplant of hepatitis C virus-positive donor kidneys is safe and feasible when combined with direct-acting antiviral therapy. However, details regarding optimal duration of treatment and directacting antiviral regimen remain undetermined, so prospective randomized studies are warranted. CONCLUSIONS Our study further confirms that kidney transplant from hepatitis C virus-positive donors to hepatitis C virus-negative recipients is safe and feasible with direct-acting antiviral treatment. Grafts from hepatitis C virus-infected donors may be effective to resolve the problem of kidney shortage.
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Affiliation(s)
- Halinuer Shadekejiang
- From the Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
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Jadoul M, Awan A, Berenguer M, Bruchfeld A, Fabrizi F, Goldberg D, Jia J, Kamar N, Mohamed R, Pessôa M, Pol S, Sise M, Martin P. KDIGO 2022 Clinical Practice Guideline FOR the Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney Disease. Kidney Int 2022; 102:S129-S205. [PMID: 36410841 DOI: 10.1016/j.kint.2022.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 11/19/2022]
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What's in a name? Higher risks with donation after cardiac death than public health service increased risk livers. JOURNAL OF LIVER TRANSPLANTATION 2022. [DOI: 10.1016/j.liver.2022.100133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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8
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Doherty DT, Athwal V, Moinuddin Z, Augustine T, Prince M, van Dellen D, Khambalia HA. Kidney Transplantation From Hepatitis-C Viraemic Donors:Considerations for Practice in the United Kingdom. Transpl Int 2022; 35:10277. [PMID: 35592447 PMCID: PMC9110637 DOI: 10.3389/ti.2022.10277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/11/2022] [Indexed: 12/01/2022]
Abstract
Background: Donor hepatitis-C (HCV) infection has historically represented a barrier to kidney transplantation (KT). However, direct-acting antiviral (DAA) medications have revolutionised treatment of chronic HCV infection. Recent American studies have demonstrated that DAA regimes can be used safely peri-operatively in KT to mitigate HCV transmission risk. Methods: To formulate this narrative review, a comprehensive literature search was performed to analyse results of existing clinical trials examining KT from HCV-positive donors to HCV-negative recipients with peri-operative DAA regimes. Results: 13 studies were reviewed (11 single centre, four retrospective). Outcomes for 315 recipients were available across these studies. A sustained virological response at 12 weeks (SVR12) of 100% was achieved in 11 studies. One study employed an ultra-short DAA regime and achieved an SVR12 of 98%, while another achieved SVR12 of 96% due to treatment of a missed mixed genotype. Conclusion: HCV+ KT is safe and may allow increased utilisation of organs for transplantation from HCV+ donors, who often have other favourable characteristics for successful donation. Findings from US clinical trials can be applied to the United Kingdom transplant framework to improve organ utilisation as suggested by the NHSBT vision strategy "Organ Donation and Transplantation 2030: meeting the need".
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Affiliation(s)
- Daniel T. Doherty
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Varinder Athwal
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Department of Hepatology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Zia Moinuddin
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Titus Augustine
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Martin Prince
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Department of Hepatology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - David van Dellen
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Hussein A. Khambalia
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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Sawinski D, Rosenblatt RE, Morales JM. Renal transplantation using kidneys from hepatitis C-infected donors: A review of 30-years’ experience. Nefrologia 2022. [DOI: 10.1016/j.nefro.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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10
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Odenwald MA, Paul S. Viral hepatitis: Past, present, and future. World J Gastroenterol 2022; 28:1405-1429. [PMID: 35582678 PMCID: PMC9048475 DOI: 10.3748/wjg.v28.i14.1405] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 03/04/2022] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
Each hepatitis virus-Hepatitis A, B, C, D, E, and G-poses a distinct scenario to the patient and clinician alike. Since the discovery of each virus, extensive knowledge regarding epidemiology, virologic properties, and the natural clinical and immunologic history of acute and chronic infections has been generated. Basic discoveries about host immunologic responses to acute and chronic viral infections, combined with virologic data, has led to vaccines to prevent Hepatitis A, B, and E and highly efficacious antivirals for Hepatitis B and C. These therapeutic breakthroughs are transforming the fields of hepatology, transplant medicine in general, and public and global health. Most notably, there is even an ambitious global effort to eliminate chronic viral hepatitis within the next decade. While attainable, there are many barriers to this goal that are being actively investigated in basic and clinical labs on the local, national, and international scales. Herein, we discuss pertinent clinical information and recent organizational guidelines for each of the individual hepatitis viruses while also synthesizing this information with the latest research to focus on exciting future directions for each virus.
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Affiliation(s)
- Matthew August Odenwald
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, Center for Liver Diseases, University of Chicago, Chicago, IL 60637, United States
| | - Sonali Paul
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, Center for Liver Diseases, University of Chicago, Chicago, IL 60637, United States
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Nagra N, Kozarek RA, Burman BE. Therapeutic Advances in Viral Hepatitis A-E. Adv Ther 2022; 39:1524-1552. [PMID: 35220557 DOI: 10.1007/s12325-022-02070-z] [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: 12/16/2021] [Accepted: 01/31/2022] [Indexed: 11/25/2022]
Abstract
Viral hepatitis remains a significant global health problem. All forms of viral hepatitis A through E (A-E) can lead to acute symptomatic infection, while hepatitis B and C can lead to chronic infection associated with significant morbidity and mortality related to progression to cirrhosis, end-stage-liver disease, and liver cancer. Viral hepatitis occurs worldwide, though certain regions are disproportionately affected. We now, remarkably, have highly effective curative regimens for hepatitis C, and safe and tolerable medications to suppress hepatitis B activity, and to prevent liver damage and slow disease progression. We have effective vaccines for hepatitis A and B which provide long-lasting immunity, while improved sanitation and awareness can curb outbreaks of hepatitis A and E. However, more effective and available preventive and curative strategies are needed to achieve global eradication of viral hepatitis. This review provides an overview of the epidemiology, transmission, diagnosis, and clinical features of each viral hepatitis with a primary focus on current and future therapeutic and curative options.
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Affiliation(s)
- Navroop Nagra
- Department of Gastroenterology, University of Louisville, Louisville, KY, 40202, USA
| | - Richard A Kozarek
- Center for Digestive Health, Virginia Mason Franciscan Health, 1100 9th Ave., Seattle, WA, 98101, USA
| | - Blaire E Burman
- Center for Digestive Health, Virginia Mason Franciscan Health, 1100 9th Ave., Seattle, WA, 98101, USA.
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12
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El Helou G, Jay C, Nunez M. Hepatitis C virus and kidney transplantation: Recent trends and paradigm shifts. Transplant Rev (Orlando) 2022; 36:100677. [DOI: 10.1016/j.trre.2021.100677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/28/2021] [Accepted: 12/31/2021] [Indexed: 12/09/2022]
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Huckaby LV, Seese LM, Handzel R, Wang Y, Hickey G, Kilic A. Center-level Utilization of Hepatitis C Virus-positive Donors for Orthotopic Heart Transplantation. Transplantation 2021; 105:2639-2645. [PMID: 33988340 PMCID: PMC9015733 DOI: 10.1097/tp.0000000000003674] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The use of hepatitis C virus-positive (HCV+) donors has expanded the donor pool for orthotopic heart transplantation (OHT). This study evaluated center-level trends and utilization of HCV+ donors for OHT. METHODS Data were extracted from the Scientific Registry of Transplant Recipients on adults (≥18 y) undergoing OHT between January 1, 2016 and December 31, 2019. Centers performing <10 OHTs during the study period were excluded. Donor utilization rates were evaluated at the center level. Center-level characteristics were compared between centers performing HCV+ donor hepatitis C virus-negative (HCV-) recipient OHTs and those not utilizing HCV+ donors for HCV- recipients. RESULTS A total of 10 134 patients underwent OHT, including 613 (6.05%) HCV+ donors transplanted into HCV- recipients. The number of HCV+ OHTs increased from 15 of 2512 (0.60%) in 2016 to 285 of 2490 (11.45%) in 2019 (P < 0.001). In 2016, among 105 centers performing OHTs, 7 (6.67%) utilized HCV+ donors compared to 2019 during which 55 (52.89%) of 104 centers utilized HCV+ donors (P < 0.001). In total, 57 of 107 (53.27%) centers utilized HCV+ donors during the study period. Centers utilizing HCV+ donors had higher overall donor utilization rates (7376/24 378 [30.26%] versus 3463/15 335 [22.58%], P < 0.001) and were higher volume as compared to nonutilizing centers (mean annual OHT volume 30.72 ± 1.21 versus 16.2 ± 1.40, P < 0.001). CONCLUSIONS Although the use of HCV+ donors for OHT is rapidly expanding in the United States, almost half of transplant centers remain nonutilizers. Broader education and implementation of HCV+ donor protocols may be important in expanding OHT to more patients with end-stage heart failure.
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Affiliation(s)
- Lauren V. Huckaby
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Laura M. Seese
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Robert Handzel
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Yisi Wang
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Gavin Hickey
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Arman Kilic
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
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Gillman CE, Jayasuriya AC. FDA-approved bone grafts and bone graft substitute devices in bone regeneration. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 130:112466. [PMID: 34702541 PMCID: PMC8555702 DOI: 10.1016/j.msec.2021.112466] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/26/2021] [Accepted: 09/24/2021] [Indexed: 12/28/2022]
Abstract
To induce bone regeneration there is a complex cascade of growth factors. Growth factors such as recombinant BMP-2, BMP-7, and PDGF are FDA-approved therapies in bone regeneration. Although, BMP shows promising results as being an alternative to autograft, it also has its own downfalls. BMP-2 has many adverse effects such as inflammatory complications such as massive soft-tissue swelling that can compromise a patient's airway, ectopic bone formation, and tumor formation. BMP-2 may also be advantageous for patients not willing to give up smoking as it shows bone regeneration success with smokers. BMP-7 is no longer an option for bone regeneration as it has withdrawn off the market. PDGF-BB grafts in studies have shown PDGF had similar fusion rates to autologous grafts and fewer adverse effects. There is also an FDA-approved bioactive molecule for bone regeneration, a peptide P-15. P-15 was found to be effective, safe, and have similar outcomes to autograft at 2 years post-op for cervical radiculopathy due to cervical degenerative disc disease. Growth factors and bioactive molecules show some promising results in bone regeneration, although more research is needed to avoid their adverse effects and learn about the long-term effects of these therapies. There is a need of a bone regeneration method of similar quality of an autograft that is osteoconductive, osteoinductive, and osteogenic. This review covers all FDA-approved bone regeneration therapies such as the "gold standard" autografts, allografts, synthetic bone grafts, and the newer growth factors/bioactive molecules. It also covers international bone grafts not yet approved in the United States and upcoming technologies in bone grafts.
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Affiliation(s)
- Cassidy E Gillman
- The Doctor of Medicine (M.D.) Program, College of Medicine and Life Sciences, The University of Toledo, Toledo, OH 43614, USA
| | - Ambalangodage C Jayasuriya
- Department of Orthopaedic Surgery, College of Medicine and Life Sciences, The University of Toledo, Toledo, OH 43614, USA.
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Franco A, Moreso F, Sancho A, Esforzado N, Paul J, Llorente S, Crespo M, Guirado L, Melilli E, Roncero FG. Protocol for Optimizing the Use of Kidneys From Donors With Seropositivity for Hepatitis C Virus in Seronegative Recipients. Transplant Proc 2021; 53:2655-2658. [PMID: 34657711 DOI: 10.1016/j.transproceed.2021.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The rapid identification of the viral load from hepatitis C virus (HCV) in seropositive donors enables the determination of their infection capacity and the subsequent design of a strategy to optimize the use of direct-action antivirals (DAA) in seronegative recipients. In 2017, we designed an optimization protocol; this study aims to assess its efficacy and safety. METHODS This is a prospective, multicenter observational study that complies with the Declarations of Helsinki and Istanbul. Donors were HCV seropositive. The HCV and human immunodeficiency virus loads were immediately determined in the donors. For viremic donors, recipients were treated with DAA for 8 weeks. For nonviremic donors, DAA was started if a viral load was detected during the follow-up period. The minimum follow-up period was 6 months posttransplant. RESULTS This study recruited 28 donors. Just over half of the donors (n = 15; 53.5%) had a nonactive history of injection drug use. Eight (22.4%) donors were viremic, and 20 (87.6%) were nonviremic; 13 (65%) had been treated previously. Nine grafts were ineligible for the protocol. We performed a total of 47 transplants. Procedure I (viremic donors) was performed in 13 recipients (27.7%). Posttransplant viremia was observed in 6 participants. Posttransplant viremia was low (<100 IU/mL) in 4 participants but high (36,000 and 138,000 IU/mL) in 2 participants who had initiated DAA after the transplant; all these patients had a sustained viral response. Seroconversion was observed in 11 of 13 (84.6%) patients. Procedure II (nonviremic donors) was undertaken in 34 (82.3%) patients. No positive viral loads were observed. Seroconversion occurred in 7 of 34 (20.5%) recipients. All recipients maintained kidney function at 6 months posttransplant, except 1 patient with a graft that had never been functional and another patient who died of pancreatitis. Both patients had received kidneys from nonviremic donors. CONCLUSIONS Our experience supports the efficacy and safety of this protocol.
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Affiliation(s)
- Antonio Franco
- Department of Nephrology, Hospital General Universitario, Alicante, Spain.
| | - Francesc Moreso
- Department of Nephrology, Hospital Valld´Hebron, Barcelona, Spain; Department of Nephrology, Hospital Doctor Peset, Valencia, Spain
| | - Asuncion Sancho
- Department of Nephrology, Hospital Doctor Peset, Valencia, Spain
| | | | - Javier Paul
- Department of Nephrology, Hospital Miguel Servet, Zaragoza, Spain
| | - Santiago Llorente
- Department of Nephrology, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Luis Guirado
- Department of Nephrology, Hospital Puigvert, Barcelona, Spain
| | - Eduardo Melilli
- Department of Nephrology, Hospital Belvitge, Barcelona, Spain
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16
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Inner Workings: Advances in infectious disease treatment promise to expand the pool of donor organs. Proc Natl Acad Sci U S A 2021; 118:2100577118. [PMID: 33597292 DOI: 10.1073/pnas.2100577118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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17
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Lonze BE, Baptiste G, Ali NM, Dagher NN, Gelb BE, Mattoo A, Soomro I, Tatapudi VS, Montgomery RA, Stewart ZA. Pancreas transplantation from hepatitis C viremic donors to uninfected recipients. Am J Transplant 2021; 21:1931-1936. [PMID: 33346951 DOI: 10.1111/ajt.16465] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/13/2020] [Accepted: 12/15/2020] [Indexed: 01/25/2023]
Abstract
Despite utilization of hepatitis C viremic organs for hepatitis C naïve recipients (HCV D+/R-) in other solid organ transplants, HCV viremic pancreata remain an unexplored source of donor organs. This study reports the first series of HCV D+/R- pancreas transplants. HCV D+/R- had shorter waitlist times compared to HCV D-/R-, waiting a mean of 16 days from listing for HCV-positive organs. HCV D+/R- had a lower match allocation sequence than HCV D-/R-, and this correlated with receipt of organs with a lower Pancreas Donor Risk Index (PDRI) score. All HCV D+/R- had excellent graft function with a mean follow-up of 438 days and had undetectable HCV RNA levels by a mean of 23 days after initiation of HCV-directed therapy. The rates of infectious complications, reoperation, readmission, rejection, and length of stay were not impacted by donor HCV status. A national review of potential ideal pancreas donors found that 37% of ideal HCV-negative pancreas allografts were transplanted, compared to only 5% of ideal HCV-positive pancreas allografts. The results of the current study demonstrate the safety of accepting HCV-positive pancreata for HCV-naïve recipients and advocates for increased utilization of ideal HCV-positive pancreas allografts.
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Affiliation(s)
- Bonnie E Lonze
- Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Gillian Baptiste
- Department of Surgery, NYU Langone Health, New York, New York, USA
| | - Nicole M Ali
- Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Nabil N Dagher
- Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Bruce E Gelb
- Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Aprajita Mattoo
- Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Irfana Soomro
- Transplant Institute, NYU Langone Health, New York, New York, USA
| | | | | | - Zoe A Stewart
- Transplant Institute, NYU Langone Health, New York, New York, USA
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18
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Chang SH, Merzkani M, Lentine KL, Wang M, Axelrod DA, Anwar S, Schnitzler MA, Wellen J, Chapman WC, Alhamad T. Trends in Discard of Kidneys from Hepatitis C Viremic Donors in the United States. Clin J Am Soc Nephrol 2021; 16:251-261. [PMID: 33451990 PMCID: PMC7863640 DOI: 10.2215/cjn.10960720] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/17/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Kidneys from hepatitis C virus (HCV) viremic donors have become more commonly accepted for transplant, especially after effective direct-acting antiviral therapy became available in 2014. We examined the contemporary trend of kidney discard from donors with HCV seropositivity and viremia. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Data from the Organ Procurement and Transplantation Network were used to identify deceased donor kidneys recovered for transplant. The exposure was donor HCV antibody status in the first analyses, and donor HCV antibody and viremia status in the second analyses. Multilevel, multivariable logistic regression was used to assess the association of these HCV exposure measures with kidney discard, adjusted for donor characteristics. Multilevel analyses were conducted to account for similar kidney discard pattern within clusters of organ procurement organizations and regions. RESULTS Among 225,479 kidneys recovered from 2005 to 2019, 5% were from HCV seropositive donors. Compared with HCV seronegative kidneys, the odds of HCV seropositive kidney discard gradually declined, from a multivariable-adjusted odds ratio (aOR) of 7.06 (95% confidence interval [95% CI], 5.65 to 8.81) in 2014, to 1.20 (95% CI, 1.02 to 1.42) in 2019. Among 82,090 kidneys with nucleic acid amplification test results in 2015-2019, 4% were from HCV viremic donors and 2% were from aviremic seropositive donors. Compared with HCV aviremic seronegative kidneys, the odds of HCV viremic kidney discard decreased from an aOR of 4.89 (95% CI, 4.03 to 5.92) in 2018, to 1.48 (95% CI, 1.22 to 1.81) in 2019. By 2018 and 2019, aviremic seropositive status was not associated with higher odds of discard (2018: aOR, 1.13; 95% CI, 0.88 to 1.45; and 2019: aOR, 0.97; 95% CI, 0.76 to 1.23). CONCLUSIONS Despite the decrease in kidney discard in recent years, kidneys from viremic (compared with aviremic seronegative) donors still had 48% higher odds of discard in 2019. The potential of these discarded organs to provide successful transplantation should be explored.
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Affiliation(s)
- Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Massini Merzkani
- Division of Nephrology, Washington University School of Medicine, St. Louis, Missouri,Transplant Epidemiology Research Collaboration, Institute of Public Health, Washington University School of Medicine, St. Louis, Missouri
| | - Krista L. Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Mei Wang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Siddiq Anwar
- Division of Nephrology, Seha Kidney Care, Abu Dhabi, United Arab Emirates
| | - Mark A. Schnitzler
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Jason Wellen
- Department of Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - William C. Chapman
- Department of Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Tarek Alhamad
- Division of Nephrology, Washington University School of Medicine, St. Louis, Missouri,Transplant Epidemiology Research Collaboration, Institute of Public Health, Washington University School of Medicine, St. Louis, Missouri
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19
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Wang SJ, Huang CF, Yu ML. Elbasvir and grazoprevir for the treatment of hepatitis C. Expert Rev Anti Infect Ther 2021; 19:1071-1081. [PMID: 33428488 DOI: 10.1080/14787210.2021.1874351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Hepatitis C is one of the leading causes of chronic liver disease. The direct-acting-antivirals has revolutionized the chronic hepatitis C treatment. DAAs can achieve a sustained virological response rate >95% in different populations.Area covered: This review summarizes the pharmacokinetics, pharmacodynamics, efficacy, and safety of Elbasvir/Grazoprevir (EBR/GZR).Expert opinion: EBR/GZR is a combination of NS5A and NS3/4A inhibitors. The performance in the EBR/GZR combination's safety and tolerability is appreciated in clinical treatment. EBR/GZR also has a higher barrier to resistance-associated substitutions. Based on clinical trials and real-world experience, elbasvir/grazoprevir is effective in the HCV GT1, 4 infections.
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Affiliation(s)
- Szu-Jen Wang
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Gastroenterology, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Chung-Feng Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Lung Yu
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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20
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Early Outcomes of Multivisceral Transplant Using Hepatitis C-Positive Donors. Ann Thorac Surg 2020; 112:511-518. [PMID: 33121968 DOI: 10.1016/j.athoracsur.2020.08.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 08/19/2020] [Accepted: 08/31/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND In the era of direct-acting antiviral therapies, hepatitis C-positive organs offer a strategy to expand the donor pool. Heart failure patients with concomitant renal insufficiency benefit from combined heart/kidney transplant. In 2017, we began utilizing organs from hepatitis C donors for heart/kidney transplants. METHODS Characteristics and outcomes of heart/kidney transplants were collected at our institution from 2012 through 2019. We determined patient cohorts by donor hepatitis C antibody status, antibody positive (HCV+) vs antibody negative (HCV-). Outcomes of interest include survival, postoperative allograft function, and waitlist time. Summary and descriptive statistics, as well as survival analyses, were performed. RESULTS Thirty-nine patients underwent heart/kidney transplantation from 2012-2019. Twelve patients received HCV+ organs, and 27 patients received HCV- organs with minimal differences in donor and recipient cohort characteristics. Recipients who consented to receive HCV+ organs had a shorter median waitlist time. HCV+ and HCV- groups had similar perioperative and early postoperative cardiac function and similar rates of delayed renal graft function. HCV+ recipients demonstrated higher creatinine levels at 3 months posttransplant compared with HCV- recipients, but by 1-year post-transplant, creatinine levels in both groups were similar. The groups had similar 30-day and 1-year survival. CONCLUSIONS This study is a single-center series of heart/kidney transplant using HCV+ donors. When the potential increased risk of early postoperative renal dysfunction is balanced against similar survival and decreased waitlist time, the results suggest that HCV+ donors are an important source of transplantable organs for heart/kidney transplantation.
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21
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Gidea CG, Narula N, Reyentovich A, Fargnoli A, Smith D, Pavone J, Lewis T, Karpe H, Stachel M, Rao S, Moreira A, Saraon T, Raimann J, Kon Z, Moazami N. Increased early acute cellular rejection events in hepatitis C-positive heart transplantation. J Heart Lung Transplant 2020; 39:1199-1207. [PMID: 32739334 DOI: 10.1016/j.healun.2020.06.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Increased utilization of hepatitis C virus (HCV)-positive donors has increased transplantation rates. However, high levels of viremia have been documented in recipients of viremic donors. There is a knowledge gap in how transient viremia may impact acute cellular rejections (ACRs). METHODS In this study, 50 subjects received hearts from either viremic or non-viremic donors. The recipients of viremic donors were classified as nucleic acid amplification testing (NAT)+ group, and the remaining were classified as NAT-. All patients were monitored for viremia levels. Endomyocardial biopsies were performed through 180 days, evaluating the incidence of ACRs. RESULTS A total of 50 HCV-naive recipients received hearts between 2018 and 2019. A total of 22 patients (44%) who received transplants from viremic donors developed viremia at a mean period of 7.2 ± 0.2 days. At that time, glecaprevir/pibrentasvir was initiated. In the viremia period (<56 days), 14 of 22 NAT+ recipients (64%) had ACR vs 5 of 28 NAT- group (18%) (p = 0.001). Through 180 days, 17 of 22 NAT+ recipients (77%) had a repeat rejection biopsy vs 12 of 28 NAT- recipients (43%) (p = 0.02). NAT+ biopsies demonstrated disparity of ACR distribution: negative, low-grade, and high-grade ACR in 84%, 12%, and 4%, respectively, vs 96%, 3%, and 1%, respectively, in the NAT- group (p = 0.03). The median time to first event was 26 (interquartile range [IQR]: 8-45) in the NAT+ group vs 65 (IQR: 44-84) days in the NAT-. Time to first event risk model revealed that NAT+ recipients had a significantly higher rate of ACR occurrences, adjusting for demographics (p = 0.004). CONCLUSIONS Transient levels of viremia contributed to higher rates and severity of ACRs. Further investigation into the mechanisms of early immune activation in NAT+ recipients is required.
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Affiliation(s)
| | | | | | | | | | | | - Tyler Lewis
- Pharmacy, NYU Langone Medical Center, New York, New York
| | - Hannah Karpe
- Medical School, New York University School of Medicine, New York, New York
| | | | - Shaline Rao
- Division of Cardiology, Department of Medicine
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22
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Yu ML, Chen PJ, Dai CY, Hu TH, Huang CF, Huang YH, Hung CH, Lin CY, Liu CH, Liu CJ, Peng CY, Lin HC, Kao JH, Chuang WL. 2020 Taiwan consensus statement on the management of hepatitis C: Part (II) special populations. J Formos Med Assoc 2020; 119:1135-1157. [PMID: 32354689 DOI: 10.1016/j.jfma.2020.04.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/05/2020] [Indexed: 12/13/2022] Open
Abstract
Hepatitis C virus (HCV) infection is a silent killer that leads to rapid progression of liver cirrhosis and hepatocellular carcinoma (HCC). High prevalence of HCV infection has been reported in Taiwan, especially in high-risk populations including people who inject drugs (PWID) and patients requiring dialysis. Besides, certain populations merit special considerations due to suboptimal outcome, potential drug-drug interaction, or possible side effect. Therefore, in the second part of this 2-part consensus, the Taiwan Association for the Study of the Liver (TASL) proposes the treatment recommendations for the special population in order to serve as guidance to optimizing the outcome in the direct-acting antiviral (DAA) era. Special populations include patients with acute or recent HCV infection, previous DAA failure, chronic kidney disease, decompensated cirrhosis, HCC, liver and other solid organ transplantations, receiving an HCV viremic organ, hepatitis B virus (HBV) and HCV dual infection, HCV and human immunodeficiency virus (HIV) coinfection, active tuberculosis infection, PWID, bleeding disorders and hemoglobinopathies, children and adolescents, and pregnancy. Moreover, future perspectives regarding the management of hepatitis C are also discussed and summarized in this consensus statement.
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Affiliation(s)
- Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine and Hepatitis Research Center, College of Medicine, Center for Cancer Research and Center for Liquid Biopsy, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Pei-Jer Chen
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine and Hepatitis Research Center, College of Medicine, Center for Cancer Research and Center for Liquid Biopsy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsung-Hui Hu
- Division of Hepato-Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chung-Feng Huang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine and Hepatitis Research Center, College of Medicine, Center for Cancer Research and Center for Liquid Biopsy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chao-Hung Hung
- Division of Hepato-Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chun-Yen Lin
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chen-Hua Liu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Jen Liu
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Yuan Peng
- Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Han-Chieh Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jia-Horng Kao
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine and Hepatitis Research Center, College of Medicine, Center for Cancer Research and Center for Liquid Biopsy, Kaohsiung Medical University, Kaohsiung, Taiwan
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23
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Jones JM, Kracalik I, Levi ME, Bowman JS, Berger JJ, Bixler D, Buchacz K, Moorman A, Brooks JT, Basavaraju SV. Assessing Solid Organ Donors and Monitoring Transplant Recipients for Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Infection - U.S. Public Health Service Guideline, 2020. MMWR Recomm Rep 2020; 69:1-16. [PMID: 32584804 PMCID: PMC7337549 DOI: 10.15585/mmwr.rr6904a1] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The recommendations in this report supersede the U.S Public Health Service (PHS) guideline recommendations for reducing transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) through organ transplantation (Seem DL, Lee I, Umscheid CA, Kuehnert MJ. PHS guideline for reducing human immunodeficiency virus, hepatitis B virus, and hepatitis C virus transmission through organ transplantation. Public Health Rep 2013;128:247-343), hereafter referred to as the 2013 PHS guideline. PHS evaluated and revised the 2013 PHS guideline because of several advances in solid organ transplantation, including universal implementation of nucleic acid testing of solid organ donors for HIV, HBV, and HCV; improved understanding of risk factors for undetected organ donor infection with these viruses; and the availability of highly effective treatments for infection with these viruses. PHS solicited feedback from its relevant agencies, subject-matter experts, additional stakeholders, and the public to develop revised guideline recommendations for identification of risk factors for these infections among solid organ donors, implementation of laboratory screening of solid organ donors, and monitoring of solid organ transplant recipients. Recommendations that have changed since the 2013 PHS guideline include updated criteria for identifying donors at risk for undetected donor HIV, HBV, or HCV infection; the removal of any specific term to characterize donors with HIV, HBV, or HCV infection risk factors; universal organ donor HIV, HBV, and HCV nucleic acid testing; and universal posttransplant monitoring of transplant recipients for HIV, HBV, and HCV infections. The recommendations are to be used by organ procurement organization and transplant programs and are intended to apply only to solid organ donors and recipients and not to donors or recipients of other medical products of human origin (e.g., blood products, tissues, corneas, and breast milk). The recommendations pertain to transplantation of solid organs procured from donors without laboratory evidence of HIV, HBV, or HCV infection. Additional considerations when transplanting solid organs procured from donors with laboratory evidence of HCV infection are included but are not required to be incorporated into Organ Procurement and Transplantation Network policy. Transplant centers that transplant organs from HCV-positive donors should develop protocols for obtaining informed consent, testing and treating recipients for HCV, ensuring reimbursement, and reporting new infections to public health authorities.
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24
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Gupta G, Yakubu I, Bhati CS, Zhang Y, Kang L, Patterson JA, Andrews-Joseph A, Alam A, Ferreira-Gonzalez A, Kumar D, Moinuddin IK, Kamal L, King AL, Levy M, Sharma A, Cotterell A, Reichman TW, Khan A, Kimball P, Stiltner R, Baldecchi M, Brigle N, Gehr T, Sterling RK. Ultra-short duration direct acting antiviral prophylaxis to prevent virus transmission from hepatitis C viremic donors to hepatitis C negative kidney transplant recipients. Am J Transplant 2020; 20:739-751. [PMID: 31652392 DOI: 10.1111/ajt.15664] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/10/2019] [Accepted: 10/13/2019] [Indexed: 01/25/2023]
Abstract
We conducted an adaptive design single-center pilot trial between October 2017 and November 2018 to determine the safety and efficacy of ultra-short-term perioperative pangenotypic direct acting antiviral (DAA) prophylaxis for deceased hepatitis C virus (HCV)-nucleic acid test (NAT) positive donors to HCV negative kidney recipients (D+/R-). In Group 1, 10 patients received one dose of SOF/VEL (sofusbuvir/velpatasvir) pretransplant and one dose on posttransplant Day 1. In Group 2A (N = 15) and the posttrial validation (Group 2B; N = 25) phase, patients received two additional SOF/VEL doses (total 4) on Days 2 and 3 posttransplant. Development of posttransplant HCV transmission triggered 12-week DAA therapy. For available donor samples (N = 27), median donor viral load was 1.37E + 06 IU/mL (genotype [GT]1a: 70%; GT2: 7%; GT3: 23%). Overall viral transmission rate was 12% (6/50; Group 1:30% [3/10]; Group 2A:13% [2/15]; Group 2B:4% [1/25]). For the 6 viremic patients, 5 (83%) achieved sustained virologic response (3 with first-line DAA therapy; and two after retreatment with second-line DAA). At a median follow-up of 8 months posttransplant, overall patient and allograft survivals were 98%, respectively. The 4-day strategy reduced viral transmission to 7.5% (3/40; 95% confidence interval [CI]: 1.8%-20.5%) and could result in avoidance of prolonged posttransplant DAA therapy for most D+/R - transplants.
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Affiliation(s)
- Gaurav Gupta
- Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, Virginia.,Division of Transplantation, Hume-Lee Transplant Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Idris Yakubu
- Virginia Commonwealth University School of Pharmacy, Richmond, Virginia
| | - Chandra S Bhati
- Division of Transplantation, Hume-Lee Transplant Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Yiran Zhang
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia
| | - Le Kang
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Julie A Patterson
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia
| | - Ayana Andrews-Joseph
- Division of Transplantation, Hume-Lee Transplant Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Anam Alam
- Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | | | - Dhiren Kumar
- Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Irfan K Moinuddin
- Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Layla Kamal
- Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Anne L King
- Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, Virginia.,Division of Transplantation, Hume-Lee Transplant Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Marlon Levy
- Division of Transplantation, Hume-Lee Transplant Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Amit Sharma
- Division of Transplantation, Hume-Lee Transplant Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Adrian Cotterell
- Division of Transplantation, Hume-Lee Transplant Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Trevor W Reichman
- Division of Transplantation, Hume-Lee Transplant Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Aamir Khan
- Division of Transplantation, Hume-Lee Transplant Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Pamela Kimball
- Division of Transplantation, Hume-Lee Transplant Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Rodney Stiltner
- Virginia Commonwealth University School of Pharmacy, Richmond, Virginia
| | - Mary Baldecchi
- Division of Transplantation, Hume-Lee Transplant Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Nathaniel Brigle
- Division of Transplantation, Hume-Lee Transplant Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Todd Gehr
- Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Richard K Sterling
- Division of Transplantation, Hume-Lee Transplant Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia.,Section of Hepatology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
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25
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Pagan J, Ladino M, Roth D. Should My Patient Accept a Kidney from a Hepatitis C Virus-Infected Donor? KIDNEY360 2020; 1:127-129. [PMID: 35372902 PMCID: PMC8809094 DOI: 10.34067/kid.0001012019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Javier Pagan
- Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Marco Ladino
- Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida; and
- Nephrology Section, Miami Veterans Administration Healthcare System, Miami, Florida
| | - David Roth
- Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida; and
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26
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27
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Woolley AE, Piechura LM, Goldberg HJ, Singh SK, Coppolino A, Baden LR, Mallidi HR. The impact of hepatitis C viremic donor lung allograft characteristics on post-transplantation outcomes. Ann Cardiothorac Surg 2020; 9:42-48. [PMID: 32175238 DOI: 10.21037/acs.2020.01.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background There is a low utilization rate of donated donor lungs. Historically, transplantation of lungs from hepatitis C-viremic donors to hepatitis C (HCV) negative recipients was avoided due to concern for worse graft survival. In the past few years with the advent of direct acting antiviral (DAA) therapy, there are emerging data suggesting the safety and efficacy of transplanting thoracic organs from HCV-viremic donors. This study assessed the differences in donor characteristics and allograft-specific clinical features at the time of organ offer and investigated whether these variables differed in HCV-viremic versus HCV-negative donors and impacted recipient outcomes. Methods We conducted a single-center, retrospective cohort study of adult patients who underwent a lung transplant at Brigham and Women's Hospital between March 2017 and October 2018. Patients were stratified based on their donor HCV status (HCV-viremic versus HCV-negative). Donor and allograft-specific characteristics and clinical features including chest imaging and bronchoscopy reports, respiratory cultures, and the donor's oxygenation as measured by the arterial partial pressure of oxygen (PaO2) were collected as well as recipient baseline characteristics and transplant outcomes. Results During the study period, 42 and 57 lung transplants were performed from HCV-viremic and HCV-negative donors, respectively. Donor age was similar in both cohorts. More HCV-viremic donors died from drug intoxication (71% versus 19%, P=0.0001) and had a history of cigarette use (83% versus 5%, P=0.0001) and drug use (76% versus 49%, P=0.007). There were differences in the baseline recipient characteristics including a lower median lung allocation score in the HCV-viremic cohort. The organ-specific clinical characteristics including the terminal PaO2, chest imaging and bronchoscopy findings, and evidence of pulmonary infection were similar between the two cohorts. The recipient outcomes overall were excellent and did not differ significantly in both cohorts in terms of graft and patient survival at 6 and 12 months. Conclusions Despite a greater proportion of HCV-viremic donors being increased risk with a history of drug and cigarette use and having died as a result of drug intoxication, the quality of the HCV-viremic donor organs did not differ from the HCV-negative donor organs or impact graft and recipient survival. Due to an increasing number of transplants from increased risk donors and in order to develop safe and effective protocols to perform lung transplants from HCV-infected donors, further characterization of the donor and allograft-specific clinical features and longer-term recipient outcomes is greatly needed.
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Affiliation(s)
- Ann E Woolley
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura M Piechura
- Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hilary J Goldberg
- Division of Pulmonary, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Steve K Singh
- Division of Cardiac Surgery, Trillium Health Partners, University of Toronto, Toronto, Canada
| | - Antonio Coppolino
- Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lindsey R Baden
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hari R Mallidi
- Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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28
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Morales JM, Sawinski D. New insights into the rational use of HCV+ organs worldwide. Clin Transplant 2019; 33:e13739. [PMID: 31648391 DOI: 10.1111/ctr.13739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/08/2019] [Accepted: 10/15/2019] [Indexed: 01/06/2023]
Abstract
Hepatitis C (HCV) is a worldwide health problem. Effective therapies for HCV infection, coupled with an increase in deceased donors due to the opioid epidemic, have led to the broader availability and the use of HCV-infected donor organs, including HCV nucleic acid test-positive (NAT+) donors in HCV-negative recipients. In this review, we discuss the prevalence of HCV infection, trends in the use of HCV-infected donors, and outcomes for those who receive HCV-seropositive or HCV NAT+ donor organs. We discuss management considerations such as hepatitis B reactivation, selection of the optimal direct-acting antiviral regimen, and potential complications. We also present a framework for the rational use of HCV-infected donor organs in the future.
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Affiliation(s)
- Jose M Morales
- Research Institute, Hospital 12 de Octubre, Complutense University, Madrid, Spain
| | - Deirdre Sawinski
- Renal, Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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29
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Chan EG, Chan PG, Sanchez PG. Expanding the pool: the use of hepatitis C RNA positive organs in lung transplantation. J Thorac Dis 2019; 11:S1888-S1890. [PMID: 31632776 DOI: 10.21037/jtd.2019.08.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Ernest G Chan
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Patrick G Chan
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Pablo G Sanchez
- Department of Cardiothoracic Surgery, Division of Lung Transplantation, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Abstract
BACKGROUND The prevalence and clinical epidemiological profile of hepatitis C virus (HCV) infection have changed over time. AIM This study aimed to evaluate these changes in renal transplant recipients (RTx) comparing two different decades. MATERIALS AND METHODS RTx with HCV referred to RTx from 1993 to 2003 (A) and from 2004 to 2014 (B) were studied retrospectively. The demographic and clinical characteristics and different outcomes were compared between groups A and B. Variables that were statistically different were tested for inclusion in a multivariate Cox proportional hazard model predicting patient survival within the group. RESULTS Among 11 715 RTx, the prevalence of HCV was 7% in A and 4.9% in B. In the more recent period (B), the mean age was older (46.2 vs. 39.5 years), with more males (72 vs. 60.7%), larger number of deceased donors (74 vs. 55%), higher percentage of previous RTx (27 vs. 13.7%), less frequent history of blood transfusion (81 vs. 89.4%), lower prevalence of hepatitis B virus coinfection (4.7 vs. 21.4%), and higher percentage of cirrhotic patients (13 vs. 5%). Patients of group B more frequently underwent treatment of HCV (29 vs. 9%), less frequently used azathioprine (38.6 vs. 60.7%) and cyclosporine (11.8 vs. 74.7%), and more frequently used tacrolimus (91 vs. 27.3%). In the outcomes, graft loss showed no difference between periods; however, decompensation was more frequent (P = 0.007) and patients' survival was lower in the more recent period (P = 0.032) compared with the earlier one. CONCLUSION The profile of RTx with HCV has changed over the last 20 years. Despite a decrease in the prevalence of HCV, new clinical challenges have emerged, such as more advanced age and a higher prevalence of cirrhosis.
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Bethea ED, Gaj K, Gustafson JL, Axtell A, Lebeis T, Schoenike M, Turvey K, Coglianese E, Thomas S, Newton-Cheh C, Ibrahim N, Carlson W, Ho JE, Shah R, Nayor M, Gift T, Shao S, Dugal A, Markmann J, Elias N, Yeh H, Andersson K, Pratt D, Bhan I, Safa K, Fishman J, Kotton C, Myoung P, Villavicencio MA, D'Alessandro D, Chung RT, Lewis GD. Pre-emptive pangenotypic direct acting antiviral therapy in donor HCV-positive to recipient HCV-negative heart transplantation: an open-label study. Lancet Gastroenterol Hepatol 2019; 4:771-780. [PMID: 31353243 DOI: 10.1016/s2468-1253(19)30240-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 06/06/2019] [Accepted: 06/17/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Low donor heart availability underscores the need to identify all potentially transplantable organs. We sought to determine whether pre-emptive administration of pangenotypic direct-acting antiviral therapy can safely prevent the development of chronic hepatitis C virus (HCV) infection in uninfected recipients of HCV-infected donor hearts. METHODS Patients were recruited for this an open-label, single-centre, proof-of-concept study from Nov 1, 2017, to Nov 30, 2018. Following enrolment, the recipient's status on the heart transplantation waiting list was updated to reflect a willingness to accept either an HCV-positive or HCV-negative heart donor. Patients who underwent transplantation with a viraemic donor heart, as determined by nucleic acid testing (NAT), received pre-emptive oral glecaprevir-pibrentasvir before transport to the operating room followed by an 8-week course of glecaprevir-pibrentasvir after transplantation. Patients receiving HCV antibody-positive donor hearts without detectable circulating HCV RNA were followed using a reactive approach and started glecaprevir-pibrentasvir only if they developed viraemia. The primary outcome was achievement of sustained virological response 12 weeks after completion of glecaprevir-pibrentasvir therapy (SVR12). Patients were followed from study enrolment to 1 year after transplantation. This is an interim analysis, initiated after all enrolled patients reached the primary outcome. Results reflect data from Nov 1, 2017, to May 30, 2019. This trial is registered with ClinicalTrials.gov, number NCT03208244. FINDINGS 55 patients were assessed for eligibility and 52 consented to enrolment. 25 patients underwent heart transplantation with HCV-positive donor hearts (20 NAT-positive, five NAT-negative), three of whom underwent simultaneous heart-kidney transplantation. All 20 recipients of NAT-positive hearts tolerated glecaprevir-pibrentasvir and showed rapid viral suppression (median time to clearance 3·5 days, IQR 0·0-8·3), with the subsequent achievement of SVR12 by all 20. The five recipients of NAT-negative grafts did not become viraemic. Median pre-transplant waiting time for patients following enrolment in the HCV protocol was 20 days (IQR 8-57). Patient and allograft survival were 100% at a median follow-up of 10·7 months (range 6·5-18·0). INTERPRETATION Pre-emptive administration of glecaprevir-pibrentasvir therapy results in expedited organ transplantation, rapid HCV suppression, prevention of chronic HCV infection, and excellent early allograft function in patients receiving HCV-infected donor hearts. Long-term outcomes are not yet known. FUNDING American Association for the Study of Liver Diseases, National Institutes of Health, and the Massachusetts General Hospital.
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Affiliation(s)
- Emily D Bethea
- Harvard Medical School, Boston, MA, USA; Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA
| | - Kerry Gaj
- Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
| | - Jenna L Gustafson
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA
| | - Andrea Axtell
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA; Cardiothoracic Surgery Division, Massachusetts General Hospital, Boston, MA, USA
| | - Taylor Lebeis
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
| | - Mark Schoenike
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
| | - Karen Turvey
- Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
| | - Erin Coglianese
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
| | - Sunu Thomas
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher Newton-Cheh
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
| | - Nasrien Ibrahim
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
| | - William Carlson
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer E Ho
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
| | - Ravi Shah
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew Nayor
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
| | - Thais Gift
- Division of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah Shao
- Division of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Amanda Dugal
- Division of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - James Markmann
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA; Transplant Surgery Division, Massachusetts General Hospital, Boston, MA, USA
| | - Nahel Elias
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA; Transplant Surgery Division, Massachusetts General Hospital, Boston, MA, USA
| | - Heidi Yeh
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA; Transplant Surgery Division, Massachusetts General Hospital, Boston, MA, USA
| | - Karin Andersson
- Harvard Medical School, Boston, MA, USA; Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel Pratt
- Harvard Medical School, Boston, MA, USA; Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA
| | - Irun Bhan
- Harvard Medical School, Boston, MA, USA; Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA
| | - Kassem Safa
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA; Nephrology Division, Massachusetts General Hospital, Boston, MA, USA
| | - Jay Fishman
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA; Infectious Diseases Division, Massachusetts General Hospital, Boston, MA, USA
| | - Camille Kotton
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA; Infectious Diseases Division, Massachusetts General Hospital, Boston, MA, USA
| | - Paul Myoung
- Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA
| | - Mauricio A Villavicencio
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA; Cardiothoracic Surgery Division, Massachusetts General Hospital, Boston, MA, USA; Transplant Surgery Division, Massachusetts General Hospital, Boston, MA, USA
| | - David D'Alessandro
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA; Cardiothoracic Surgery Division, Massachusetts General Hospital, Boston, MA, USA; Transplant Surgery Division, Massachusetts General Hospital, Boston, MA, USA
| | - Raymond T Chung
- Harvard Medical School, Boston, MA, USA; Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA.
| | - Gregory D Lewis
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital Transplant Center, Massachusetts General Hospital, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
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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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Cotter TG, Paul S, Sandıkçı B, Couri T, Bodzin AS, Little EC, Sundaram V, Charlton M. Increasing Utilization and Excellent Initial Outcomes Following Liver Transplant of Hepatitis C Virus (HCV)-Viremic Donors Into HCV-Negative Recipients: Outcomes Following Liver Transplant of HCV-Viremic Donors. Hepatology 2019; 69:2381-2395. [PMID: 30706517 DOI: 10.1002/hep.30540] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 01/23/2019] [Indexed: 12/11/2022]
Abstract
Direct-acting antiviral (DAA) therapy has altered the frequency and outcome of liver transplantation (LT) for hepatitis C virus (HCV). The high efficacy and tolerability of DAA therapy has also created a rationale for utilizing HCV-viremic (HCV-RNA-positive) donors, including into HCV-negative recipients. We examined trends in frequency of organ utilization and graft survival in recipients of HCV-viremic donors (HCV-RNA positive as measured by nucleic acid testing [NAT]). Data were collected from the Scientific Registry of Transplant Recipients (SRTR) on adult patients who underwent a primary, single-organ, deceased donor LT from January 1, 2008 to January 31, 2018. Outcomes of HCV-negative transplant recipients (R- ) who received an allograft from donors who were HCV-RNA positive (DNAT+ ) were compared to outcomes for R- patients who received organs from donors who were HCV-RNA negative (DNAT- ). There were 11,270 DNAT- /R- ; 4,748 DNAT- /R+ ; 87 DNAT+ /R- ; and 753 DNAT+ /R+ patients, with 2-year graft survival similar across all groups: DNAT- /R- 88%; DNAT- /R+ 88%; DNAT+ /R- 86%; and DNAT+ /R+ 90%. Additionally, there were 2,635 LTs using HCV antibody-positive donors (DAb+ ): 2,378 DAb+ /R+ and 257 DAb+ /R- . The annual number of DAb+ /R- transplants increased from seven in 2008 to 107 in 2017. In the post-DAA era, graft survival improved for all recipients, with 3-year survival of DAb+ /R- patients and DAb+ /R+ patients increasing to 88% from 79% and to 85% from 78%, respectively. Conclusion: The post-DAA era has seen increased utilization of HCV-viremic donor livers, including HCV-viremic livers into HCV-negative recipients. Early graft outcomes are similar to those of HCV-negative recipients. These results support utilization of HCV-viremic organs in selected recipients both with and without HCV infection.
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Affiliation(s)
- Thomas G Cotter
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, IL
| | - Sonali Paul
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, IL
| | | | - Thomas Couri
- Department of Medicine, The University of Chicago Medicine, Chicago, IL
| | - Adam S Bodzin
- Department of Surgery, Section of Abdominal Organ Transplantation, The University of Chicago Medicine, Chicago, IL
| | | | - Vinay Sundaram
- Division of Gastroenterology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michael Charlton
- Center for Liver Diseases, The University of Chicago Medicine, Chicago, IL
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Woolley AE, Singh SK, Goldberg HJ, Mallidi HR, Givertz MM, Mehra MR, Coppolino A, Kusztos AE, Johnson ME, Chen K, Haddad EA, Fanikos J, Harrington DP, Camp PC, Baden LR. Heart and Lung Transplants from HCV-Infected Donors to Uninfected Recipients. N Engl J Med 2019; 380:1606-1617. [PMID: 30946553 PMCID: PMC7369135 DOI: 10.1056/nejmoa1812406] [Citation(s) in RCA: 247] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hearts and lungs from donors with hepatitis C viremia are typically not transplanted. The advent of direct-acting antiviral agents to treat hepatitis C virus (HCV) infection has raised the possibility of substantially increasing the donor organ pool by enabling the transplantation of hearts and lungs from HCV-infected donors into recipients who do not have HCV infection. METHODS We conducted a trial involving transplantation of hearts and lungs from donors who had hepatitis C viremia, irrespective of HCV genotype, to adults without HCV infection. Sofosbuvir-velpatasvir, a pangenotypic direct-acting antiviral regimen, was preemptively administered to the organ recipients for 4 weeks, beginning within a few hours after transplantation, to block viral replication. The primary outcome was a composite of a sustained virologic response at 12 weeks after completion of antiviral therapy for HCV infection and graft survival at 6 months after transplantation. RESULTS A total of 44 patients were enrolled: 36 received lung transplants and 8 received heart transplants. The median viral load in the HCV-infected donors was 890,000 IU per milliliter (interquartile range, 276,000 to 4.63 million). The HCV genotypes were genotype 1 (in 61% of the donors), genotype 2 (in 17%), genotype 3 (in 17%), and indeterminate (in 5%). A total of 42 of 44 recipients (95%) had a detectable hepatitis C viral load immediately after transplantation, with a median of 1800 IU per milliliter (interquartile range, 800 to 6180). Of the first 35 patients enrolled who had completed 6 months of follow-up, all 35 patients (100%; exact 95% confidence interval, 90 to 100) were alive and had excellent graft function and an undetectable hepatitis C viral load at 6 months after transplantation; the viral load became undetectable by approximately 2 weeks after transplantation, and it subsequently remained undetectable in all patients. No treatment-related serious adverse events were identified. More cases of acute cellular rejection for which treatment was indicated occurred in the HCV-infected lung-transplant recipients than in a cohort of patients who received lung transplants from donors who did not have HCV infection. This difference was not significant after adjustment for possible confounders. CONCLUSIONS In patients without HCV infection who received a heart or lung transplant from donors with hepatitis C viremia, treatment with an antiviral regimen for 4 weeks, initiated within a few hours after transplantation, prevented the establishment of HCV infection. (Funded by the Mendez National Institute of Transplantation Foundation and others; DONATE HCV ClinicalTrials.gov number, NCT03086044.).
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Affiliation(s)
- Ann E Woolley
- From the Divisions of Infectious Diseases (A.E.W., A.E.K., M.E.J., K.C., E.A.H., L.R.B.), Cardiac Surgery (S.K.S., H.R.M.), Thoracic Surgery (S.K.S., H.R.M., A.C., P.C.C.), Pulmonary and Critical Care Medicine (H.J.G.), and Cardiovascular Medicine (M.M.G., M.R.M.), and the Department of Pharmacy (J.F.), Brigham and Women's Hospital, Harvard Medical School (A.E.W., S.K.S., H.J.G., H.R.M., M.M.G., M.R.M., A.C., E.A.H., P.C.C., L.R.B.), Massachusetts College of Pharmacy and Health Sciences (J.F.), the Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute (D.P.H.), and Harvard T.H. Chan School of Public Health (D.P.H.) - all in Boston
| | - Steve K Singh
- From the Divisions of Infectious Diseases (A.E.W., A.E.K., M.E.J., K.C., E.A.H., L.R.B.), Cardiac Surgery (S.K.S., H.R.M.), Thoracic Surgery (S.K.S., H.R.M., A.C., P.C.C.), Pulmonary and Critical Care Medicine (H.J.G.), and Cardiovascular Medicine (M.M.G., M.R.M.), and the Department of Pharmacy (J.F.), Brigham and Women's Hospital, Harvard Medical School (A.E.W., S.K.S., H.J.G., H.R.M., M.M.G., M.R.M., A.C., E.A.H., P.C.C., L.R.B.), Massachusetts College of Pharmacy and Health Sciences (J.F.), the Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute (D.P.H.), and Harvard T.H. Chan School of Public Health (D.P.H.) - all in Boston
| | - Hilary J Goldberg
- From the Divisions of Infectious Diseases (A.E.W., A.E.K., M.E.J., K.C., E.A.H., L.R.B.), Cardiac Surgery (S.K.S., H.R.M.), Thoracic Surgery (S.K.S., H.R.M., A.C., P.C.C.), Pulmonary and Critical Care Medicine (H.J.G.), and Cardiovascular Medicine (M.M.G., M.R.M.), and the Department of Pharmacy (J.F.), Brigham and Women's Hospital, Harvard Medical School (A.E.W., S.K.S., H.J.G., H.R.M., M.M.G., M.R.M., A.C., E.A.H., P.C.C., L.R.B.), Massachusetts College of Pharmacy and Health Sciences (J.F.), the Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute (D.P.H.), and Harvard T.H. Chan School of Public Health (D.P.H.) - all in Boston
| | - Hari R Mallidi
- From the Divisions of Infectious Diseases (A.E.W., A.E.K., M.E.J., K.C., E.A.H., L.R.B.), Cardiac Surgery (S.K.S., H.R.M.), Thoracic Surgery (S.K.S., H.R.M., A.C., P.C.C.), Pulmonary and Critical Care Medicine (H.J.G.), and Cardiovascular Medicine (M.M.G., M.R.M.), and the Department of Pharmacy (J.F.), Brigham and Women's Hospital, Harvard Medical School (A.E.W., S.K.S., H.J.G., H.R.M., M.M.G., M.R.M., A.C., E.A.H., P.C.C., L.R.B.), Massachusetts College of Pharmacy and Health Sciences (J.F.), the Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute (D.P.H.), and Harvard T.H. Chan School of Public Health (D.P.H.) - all in Boston
| | - Michael M Givertz
- From the Divisions of Infectious Diseases (A.E.W., A.E.K., M.E.J., K.C., E.A.H., L.R.B.), Cardiac Surgery (S.K.S., H.R.M.), Thoracic Surgery (S.K.S., H.R.M., A.C., P.C.C.), Pulmonary and Critical Care Medicine (H.J.G.), and Cardiovascular Medicine (M.M.G., M.R.M.), and the Department of Pharmacy (J.F.), Brigham and Women's Hospital, Harvard Medical School (A.E.W., S.K.S., H.J.G., H.R.M., M.M.G., M.R.M., A.C., E.A.H., P.C.C., L.R.B.), Massachusetts College of Pharmacy and Health Sciences (J.F.), the Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute (D.P.H.), and Harvard T.H. Chan School of Public Health (D.P.H.) - all in Boston
| | - Mandeep R Mehra
- From the Divisions of Infectious Diseases (A.E.W., A.E.K., M.E.J., K.C., E.A.H., L.R.B.), Cardiac Surgery (S.K.S., H.R.M.), Thoracic Surgery (S.K.S., H.R.M., A.C., P.C.C.), Pulmonary and Critical Care Medicine (H.J.G.), and Cardiovascular Medicine (M.M.G., M.R.M.), and the Department of Pharmacy (J.F.), Brigham and Women's Hospital, Harvard Medical School (A.E.W., S.K.S., H.J.G., H.R.M., M.M.G., M.R.M., A.C., E.A.H., P.C.C., L.R.B.), Massachusetts College of Pharmacy and Health Sciences (J.F.), the Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute (D.P.H.), and Harvard T.H. Chan School of Public Health (D.P.H.) - all in Boston
| | - Antonio Coppolino
- From the Divisions of Infectious Diseases (A.E.W., A.E.K., M.E.J., K.C., E.A.H., L.R.B.), Cardiac Surgery (S.K.S., H.R.M.), Thoracic Surgery (S.K.S., H.R.M., A.C., P.C.C.), Pulmonary and Critical Care Medicine (H.J.G.), and Cardiovascular Medicine (M.M.G., M.R.M.), and the Department of Pharmacy (J.F.), Brigham and Women's Hospital, Harvard Medical School (A.E.W., S.K.S., H.J.G., H.R.M., M.M.G., M.R.M., A.C., E.A.H., P.C.C., L.R.B.), Massachusetts College of Pharmacy and Health Sciences (J.F.), the Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute (D.P.H.), and Harvard T.H. Chan School of Public Health (D.P.H.) - all in Boston
| | - Amanda E Kusztos
- From the Divisions of Infectious Diseases (A.E.W., A.E.K., M.E.J., K.C., E.A.H., L.R.B.), Cardiac Surgery (S.K.S., H.R.M.), Thoracic Surgery (S.K.S., H.R.M., A.C., P.C.C.), Pulmonary and Critical Care Medicine (H.J.G.), and Cardiovascular Medicine (M.M.G., M.R.M.), and the Department of Pharmacy (J.F.), Brigham and Women's Hospital, Harvard Medical School (A.E.W., S.K.S., H.J.G., H.R.M., M.M.G., M.R.M., A.C., E.A.H., P.C.C., L.R.B.), Massachusetts College of Pharmacy and Health Sciences (J.F.), the Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute (D.P.H.), and Harvard T.H. Chan School of Public Health (D.P.H.) - all in Boston
| | - Megan E Johnson
- From the Divisions of Infectious Diseases (A.E.W., A.E.K., M.E.J., K.C., E.A.H., L.R.B.), Cardiac Surgery (S.K.S., H.R.M.), Thoracic Surgery (S.K.S., H.R.M., A.C., P.C.C.), Pulmonary and Critical Care Medicine (H.J.G.), and Cardiovascular Medicine (M.M.G., M.R.M.), and the Department of Pharmacy (J.F.), Brigham and Women's Hospital, Harvard Medical School (A.E.W., S.K.S., H.J.G., H.R.M., M.M.G., M.R.M., A.C., E.A.H., P.C.C., L.R.B.), Massachusetts College of Pharmacy and Health Sciences (J.F.), the Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute (D.P.H.), and Harvard T.H. Chan School of Public Health (D.P.H.) - all in Boston
| | - Kaiwen Chen
- From the Divisions of Infectious Diseases (A.E.W., A.E.K., M.E.J., K.C., E.A.H., L.R.B.), Cardiac Surgery (S.K.S., H.R.M.), Thoracic Surgery (S.K.S., H.R.M., A.C., P.C.C.), Pulmonary and Critical Care Medicine (H.J.G.), and Cardiovascular Medicine (M.M.G., M.R.M.), and the Department of Pharmacy (J.F.), Brigham and Women's Hospital, Harvard Medical School (A.E.W., S.K.S., H.J.G., H.R.M., M.M.G., M.R.M., A.C., E.A.H., P.C.C., L.R.B.), Massachusetts College of Pharmacy and Health Sciences (J.F.), the Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute (D.P.H.), and Harvard T.H. Chan School of Public Health (D.P.H.) - all in Boston
| | - Esther A Haddad
- From the Divisions of Infectious Diseases (A.E.W., A.E.K., M.E.J., K.C., E.A.H., L.R.B.), Cardiac Surgery (S.K.S., H.R.M.), Thoracic Surgery (S.K.S., H.R.M., A.C., P.C.C.), Pulmonary and Critical Care Medicine (H.J.G.), and Cardiovascular Medicine (M.M.G., M.R.M.), and the Department of Pharmacy (J.F.), Brigham and Women's Hospital, Harvard Medical School (A.E.W., S.K.S., H.J.G., H.R.M., M.M.G., M.R.M., A.C., E.A.H., P.C.C., L.R.B.), Massachusetts College of Pharmacy and Health Sciences (J.F.), the Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute (D.P.H.), and Harvard T.H. Chan School of Public Health (D.P.H.) - all in Boston
| | - John Fanikos
- From the Divisions of Infectious Diseases (A.E.W., A.E.K., M.E.J., K.C., E.A.H., L.R.B.), Cardiac Surgery (S.K.S., H.R.M.), Thoracic Surgery (S.K.S., H.R.M., A.C., P.C.C.), Pulmonary and Critical Care Medicine (H.J.G.), and Cardiovascular Medicine (M.M.G., M.R.M.), and the Department of Pharmacy (J.F.), Brigham and Women's Hospital, Harvard Medical School (A.E.W., S.K.S., H.J.G., H.R.M., M.M.G., M.R.M., A.C., E.A.H., P.C.C., L.R.B.), Massachusetts College of Pharmacy and Health Sciences (J.F.), the Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute (D.P.H.), and Harvard T.H. Chan School of Public Health (D.P.H.) - all in Boston
| | - David P Harrington
- From the Divisions of Infectious Diseases (A.E.W., A.E.K., M.E.J., K.C., E.A.H., L.R.B.), Cardiac Surgery (S.K.S., H.R.M.), Thoracic Surgery (S.K.S., H.R.M., A.C., P.C.C.), Pulmonary and Critical Care Medicine (H.J.G.), and Cardiovascular Medicine (M.M.G., M.R.M.), and the Department of Pharmacy (J.F.), Brigham and Women's Hospital, Harvard Medical School (A.E.W., S.K.S., H.J.G., H.R.M., M.M.G., M.R.M., A.C., E.A.H., P.C.C., L.R.B.), Massachusetts College of Pharmacy and Health Sciences (J.F.), the Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute (D.P.H.), and Harvard T.H. Chan School of Public Health (D.P.H.) - all in Boston
| | - Phillip C Camp
- From the Divisions of Infectious Diseases (A.E.W., A.E.K., M.E.J., K.C., E.A.H., L.R.B.), Cardiac Surgery (S.K.S., H.R.M.), Thoracic Surgery (S.K.S., H.R.M., A.C., P.C.C.), Pulmonary and Critical Care Medicine (H.J.G.), and Cardiovascular Medicine (M.M.G., M.R.M.), and the Department of Pharmacy (J.F.), Brigham and Women's Hospital, Harvard Medical School (A.E.W., S.K.S., H.J.G., H.R.M., M.M.G., M.R.M., A.C., E.A.H., P.C.C., L.R.B.), Massachusetts College of Pharmacy and Health Sciences (J.F.), the Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute (D.P.H.), and Harvard T.H. Chan School of Public Health (D.P.H.) - all in Boston
| | - Lindsey R Baden
- From the Divisions of Infectious Diseases (A.E.W., A.E.K., M.E.J., K.C., E.A.H., L.R.B.), Cardiac Surgery (S.K.S., H.R.M.), Thoracic Surgery (S.K.S., H.R.M., A.C., P.C.C.), Pulmonary and Critical Care Medicine (H.J.G.), and Cardiovascular Medicine (M.M.G., M.R.M.), and the Department of Pharmacy (J.F.), Brigham and Women's Hospital, Harvard Medical School (A.E.W., S.K.S., H.J.G., H.R.M., M.M.G., M.R.M., A.C., E.A.H., P.C.C., L.R.B.), Massachusetts College of Pharmacy and Health Sciences (J.F.), the Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute (D.P.H.), and Harvard T.H. Chan School of Public Health (D.P.H.) - all in Boston
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Esforzado N, Morales JM. Hepatitis C and kidney transplant: The eradication time of the virus has arrived. Nefrologia 2019; 39:458-472. [PMID: 30905391 DOI: 10.1016/j.nefro.2019.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 01/07/2019] [Accepted: 01/13/2019] [Indexed: 12/11/2022] Open
Abstract
Hepatitis C virus (HCV) infection is a factor that reduces the survival of the patient and the graft in renal transplant (RT). The availability of directly acting antivirals agents (DAAs), very effective and with an excellent safety profile, it allows eradicate HCV from patients with kidney disease, and this is a revolutionary radical change in the natural evolution of this infection, until now without effective and safe treatment for the contraindication use of interferon in kidney transplant patients. The efficiency of some DAAs for all genotypes, even in patients with renal insufficiency constitutes a huge contribution to eradicate HCV in the RT population independently the genotype, severity of kidney failure, progression of liver disease and previous anti HCV therapy. All this is raising, although with controversies, the possibility of use kidneys from infected HCV+ donors for transplant in uninfected receptors and can be treated successfully in the early post-TR, thus increasing the total "pool" of kidneys for RT.
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Franco A, Moreso F, Merino E, Sancho A, Kanter J, Gimeno A, Balibrea N, Rodriguez M, Perez Contreras F. Renal transplantation from seropositive hepatitis C virus donors to seronegative recipients in Spain: a prospective study. Transpl Int 2019; 32:710-716. [PMID: 30773693 DOI: 10.1111/tri.13410] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 08/11/2018] [Accepted: 02/11/2019] [Indexed: 01/03/2023]
Abstract
Hepatitis C virus (HCV) positive donors are identified in Spain by antibody detection (HCV-Ab) techniques while a HCV nuclear acid-testing (HCV-NAT) is not mandatory. Since it has been shown that HCV-Ab positive HCV-NAT negative donors do not universally transmit the infection, we designed a protocol based on the identification of viremia in HCV-Ab positive donors to start treatment if needed. HCV-Ab-positive donors were identified and we performed HCV-NAT immediately. Donors coinfected with HIV were excluded. Recipients with a low chance to receive a transplant, with no history of liver disease and who were negative for HCV-Ab were selected after informed consent was signed. Kidney recipients from HCV-NAT-positive donors received glecaprevir and pibrentasvir from 6 h before the transplant until 8 weeks after. Recipients from HCV-NAT-negative donors were not treated. Regular monitoring by HCV-NAT was performed to initiate antiviral treatment. We included 11 recipients from six deceased donors Four recipients received grafts from HCV-NAT-positive donors and seven patients received grafts from HCV-NAT-negative donors. None of our recipients exhibited HCV-NAT positivity during the minimum follow-up period of 6 months. Recipients from HCV-NAT-positive donors exhibited sustained virologic response at 12 weeks. One recipient from an HCV-NAT-negative donor lost his graft via a process thought to be unrelated to HCV. The remaining 10 patients had a stable functioning graft at the end of the follow-up period. Our preliminary data suggest that renal transplantation from HCV-Ab- positive donors to HCV-Ab negative recipients is safe when only the recipients of organs from HCV-NAT-positive donors are treated.
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Affiliation(s)
- Antonio Franco
- Department of Nephrology, Hospital General Alicante, Alicante, Spain
| | - Francesc Moreso
- Department of Nephrology, Hospital Universitari Vall Hebron Barcelona, Barcelona, Spain
| | - Esperanza Merino
- Department of Internal Medicine, Hospital General Alicante, Alicante, Spain
| | - Asunción Sancho
- Department of Nephrology, Hospital Dr Pesset, Valencia, Spain
| | - Julia Kanter
- Department of Nephrology, Hospital Dr Pesset, Valencia, Spain
| | - Adelina Gimeno
- Department of Microbiology, Hospital General Alicante, Alicante, Spain
| | - Noelia Balibrea
- Department of Nephrology, Hospital General Alicante, Alicante, Spain
| | - Maria Rodriguez
- Department of Hepatology, Hospital General Alicante, Alicante, Spain
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White SL, Rawlinson W, Boan P, Sheppeard V, Wong G, Waller K, Opdam H, Kaldor J, Fink M, Verran D, Webster A, Wyburn K, Grayson L, Glanville A, Cross N, Irish A, Coates T, Griffin A, Snell G, Alexander SI, Campbell S, Chadban S, Macdonald P, Manley P, Mehakovic E, Ramachandran V, Mitchell A, Ison M. Infectious Disease Transmission in Solid Organ Transplantation: Donor Evaluation, Recipient Risk, and Outcomes of Transmission. Transplant Direct 2019; 5:e416. [PMID: 30656214 PMCID: PMC6324914 DOI: 10.1097/txd.0000000000000852] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 12/11/2022] Open
Abstract
In 2016, the Transplantation Society of Australia and New Zealand, with the support of the Australian Government Organ and Tissue authority, commissioned a literature review on the topic of infectious disease transmission from deceased donors to recipients of solid organ transplants. The purpose of this review was to synthesize evidence on transmission risks, diagnostic test characteristics, and recipient management to inform best-practice clinical guidelines. The final review, presented as a special supplement in Transplantation Direct, collates case reports of transmission events and other peer-reviewed literature, and summarizes current (as of June 2017) international guidelines on donor screening and recipient management. Of particular interest at the time of writing was how to maximize utilization of donors at increased risk for transmission of human immunodeficiency virus, hepatitis C virus, and hepatitis B virus, given the recent developments, including the availability of direct-acting antivirals for hepatitis C virus and improvements in donor screening technologies. The review also covers emerging risks associated with recent epidemics (eg, Zika virus) and the risk of transmission of nonendemic pathogens related to donor travel history or country of origin. Lastly, the implications for recipient consent of expanded utilization of donors at increased risk of blood-borne viral disease transmission are considered.
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Affiliation(s)
- Sarah L White
- Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - William Rawlinson
- Serology and Virology Division, NSW Health Pathology Prince of Wales Hospital, Sydney, Australia
- Women's and Children's Health and Biotechnology and Biomolecular Sciences, University of New South Wales Schools of Medicine, Sydney, Australia
| | - Peter Boan
- Departments of Infectious Diseases and Microbiology, Fiona Stanley Hospital, Perth, Australia
- PathWest Laboratory Medicine, Perth, Australia
| | - Vicky Sheppeard
- Communicable Diseases Network Australia, New South Wales Health, Sydney, Australia
| | - Germaine Wong
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Karen Waller
- Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Helen Opdam
- Austin Health, Melbourne, Australia
- The Organ and Tissue Authority, Australian Government, Canberra, Australia
| | - John Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Michael Fink
- Austin Health, Melbourne, Australia
- Department of Surgery, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Deborah Verran
- Transplantation Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Angela Webster
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Kate Wyburn
- Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
- Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Lindsay Grayson
- Austin Health, Melbourne, Australia
- Department of Surgery, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Allan Glanville
- Department of Thoracic Medicine and Lung Transplantation, St Vincent's Hospital, Sydney, Australia
| | - Nick Cross
- Department of Nephrology, Canterbury District Health Board, Christchurch Hospital, Christchurch, New Zealand
| | - Ashley Irish
- Department of Nephrology, Fiona Stanley Hospital, Perth, Australia
- Faculty of Health and Medical Sciences, UWA Medical School, The University of Western Australia, Crawley, Australia
| | - Toby Coates
- Renal and Transplantation, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Anthony Griffin
- Renal Transplantation, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Greg Snell
- Lung Transplant, Alfred Health, Melbourne, Victoria, Australia
| | - Stephen I Alexander
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Scott Campbell
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Steven Chadban
- Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
- Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Peter Macdonald
- Department of Cardiology, St Vincent's Hospital, Sydney, Australia
- St Vincent's Hospital Victor Chang Cardiac Research Institute, University of New South Wales, Sydney, Australia
| | - Paul Manley
- Kidney Disorders, Auckland District Health Board, Auckland City Hospital, Auckland, New Zealand
| | - Eva Mehakovic
- The Organ and Tissue Authority, Australian Government, Canberra, Australia
| | - Vidya Ramachandran
- Serology and Virology Division, NSW Health Pathology Prince of Wales Hospital, Sydney, Australia
| | - Alicia Mitchell
- Department of Thoracic Medicine and Lung Transplantation, St Vincent's Hospital, Sydney, Australia
- Woolcock Institute of Medical Research, Sydney, Australia
- School of Medical and Molecular Biosciences, University of Technology, Sydney, Australia
| | - Michael Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL
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Mailly L, Wrensch F, Heydmann L, Fauvelle C, Brignon N, Zeisel MB, Pessaux P, Keck ZY, Schuster C, Fuerst TR, Foung SKH, Baumert TF. In vivo combination of human anti-envelope glycoprotein E2 and -Claudin-1 monoclonal antibodies for prevention of hepatitis C virus infection. Antiviral Res 2018; 162:136-141. [PMID: 30599173 DOI: 10.1016/j.antiviral.2018.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/14/2018] [Accepted: 12/28/2018] [Indexed: 12/20/2022]
Abstract
Despite the development of direct-acting antivirals (DAAs), hepatitis C virus (HCV) infection remains a major cause for liver disease and cancer worldwide. Entry inhibitors block virus host cell entry and, therefore, prevent establishment of chronic infection and liver disease. Due to their unique mechanism of action, entry inhibitors provide an attractive antiviral strategy in organ transplantation. In this study, we developed an innovative approach in preventing HCV infection using a synergistic combination of a broadly neutralizing human monoclonal antibody (HMAb) targeting the HCV E2 protein and a host-targeting anti-claudin 1 (CLDN1) humanized monoclonal antibody. An in vivo proof-of-concept study in human liver-chimeric FRG-NOD mice proved the efficacy of the combination therapy at preventing infection by an HCV genotype 1b infectious serum. While administration of individual antibodies at lower doses only showed a delay in HCV infection, the combination therapy was highly protective. Furthermore, the combination proved to be effective in preventing infection of primary human hepatocytes by neutralization-resistant HCV escape variants selected during liver transplantation, suggesting that a combination therapy is suited for the neutralization of difficult-to-treat variants. In conclusion, our findings suggest that the combination of two HMAbs targeting different steps of virus entry improves treatment efficacy while simultaneously reducing treatment duration and costs. Our approach not only provides a clinical perspective to employ HMAb combination therapies to prevent graft re-infection and its associated liver disease but may also help to alleviate the urgent demand for organ transplants by allowing the transplantation of organs from HCV-positive donors.
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Affiliation(s)
- Laurent Mailly
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, 67000, Strasbourg, France; Université de Strasbourg, 67000, Strasbourg, France
| | - Florian Wrensch
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, 67000, Strasbourg, France; Université de Strasbourg, 67000, Strasbourg, France
| | - Laura Heydmann
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, 67000, Strasbourg, France; Université de Strasbourg, 67000, Strasbourg, France
| | - Catherine Fauvelle
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, 67000, Strasbourg, France; Université de Strasbourg, 67000, Strasbourg, France
| | - Nicolas Brignon
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, 67000, Strasbourg, France; Université de Strasbourg, 67000, Strasbourg, France
| | - Mirjam B Zeisel
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, 67000, Strasbourg, France; Université de Strasbourg, 67000, Strasbourg, France; Inserm U1052, CNRS UMR 5286, Cancer Research Center of Lyon (CRCL), Université de Lyon (UCBL), Lyon, France
| | - Patrick Pessaux
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, 67000, Strasbourg, France; Université de Strasbourg, 67000, Strasbourg, France; Institut Hospitalo-Universitaire, Pôle Hépato-digestif, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Zhen-Yong Keck
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Catherine Schuster
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, 67000, Strasbourg, France; Université de Strasbourg, 67000, Strasbourg, France
| | - Thomas R Fuerst
- University of Maryland Institute for Bioscience and Biotechnology Research, Rockville, MD, USA; Department of Cell Biology and Molecular Genetics, University of Maryland, College Park, MD, USA
| | - Steven K H Foung
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Thomas F Baumert
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, 67000, Strasbourg, France; Université de Strasbourg, 67000, Strasbourg, France; Institut Hospitalo-Universitaire, Pôle Hépato-digestif, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Institut Universitaire de France, Paris, France.
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39
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KDIGO 2018 Clinical Practice Guideline for the Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney Disease. Kidney Int Suppl (2011) 2018; 8:91-165. [PMID: 30675443 PMCID: PMC6336217 DOI: 10.1016/j.kisu.2018.06.001] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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40
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Kiberd BA, Doucette K, Vinson AJ, Tennankore KK. Hepatitis C virus-infected kidney waitlist patients: Treat now or treat later? Am J Transplant 2018; 18:2443-2450. [PMID: 29687948 DOI: 10.1111/ajt.14891] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/23/2018] [Accepted: 04/15/2018] [Indexed: 01/25/2023]
Abstract
Currently many but not all centers transplant hepatitis C virus (HCV) viremic positive (+) donor kidneys into HCV+ recipients. Directed donation of HCV+ organs reduces the wait time to transplantation for HCV+ patients. Direct-acting antiviral (DAA) therapy can cure HCV in virtually all who are infected. Some have suggested that treatment of HCV+ waitlisted patients be deferred with the hope that earlier transplantation will provide better outcomes than early DAA therapy. However, there are not enough organs to guarantee prompt transplantation for the current waitlist of infected candidates. A Markov medical decision analysis model was created to compare the overall outcomes of delayed DAA therapy (Option 1) to immediate DAA therapy (Option 2) in waitlisted HCV+ patients. Option 1 patients were modeled to be transplanted 1 year earlier, with a higher cumulative transplant incidence (54% at 5 years post-listing vs 45% for Option 2). Despite this, Option 2 provided 0.43 (95% confidence interval [CI] 0.38-0.49) more life years than Option 1. However, Option 1 was preferred for regions with much greater access to HCV+ organs or in patients with very low HCV+-associated mortality. The best option from an individual patient's perspective will differ by region and candidate.
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Affiliation(s)
- B A Kiberd
- Departments of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - K Doucette
- University of Alberta, Edmonton, Alberta, Canada
| | - A J Vinson
- Departments of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - K K Tennankore
- Departments of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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41
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Gupta G, Zhang Y, Carroll NV, Sterling RK. Cost-effectiveness of hepatitis C-positive donor kidney transplantation for hepatitis C-negative recipients with concomitant direct-acting antiviral therapy. Am J Transplant 2018; 18:2496-2505. [PMID: 30075489 DOI: 10.1111/ajt.15054] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/13/2018] [Accepted: 07/18/2018] [Indexed: 01/25/2023]
Abstract
Pilot studies suggest that transplanting hepatitis C virus (HCV)-positive donor (D+) kidneys into HCV-negative renal transplant (RT) recipients (R-), then treating HCV with direct-acting antivirals (DAA) is clinically feasible. To determine whether this is a cost-effective approach, a decision tree model was developed to analyze costs and effectiveness over a 5-year time frame between 2 choices: RT using a D+/R- strategy compared to continuing dialysis and waiting for a HCV-negative donor (D-/R-). The strategy of accepting a HCV+ organ then treating HCV was slightly more effective and substantially less expensive and resulted in an expected 4.8 years of life (YOL) with a cost of ≈$138 000 compared to an expected 4.7 YOL with a cost of ≈$329 000 for the D-/R- strategy. The D+/R- strategy remained dominant after sensitivity analyses including the difference in RT death probabilities or acute rejection probabilities between using D+ vs D- kidney; time that D-/R- patients waited for RT; dialysis death probabilities while waitlisted for RT in the D-/R- strategy; DAA therapy expected cure rate; costs of transplant, immunosuppressives, DAA therapy, dialysis, or acute rejection. The D+/R- strategy followed by treatment with DAA is less costly and slightly more effective compared to the D-/R- strategy.
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Affiliation(s)
- Gaurav Gupta
- Division of Nephrology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.,Hume-Lee Transplant Center, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Yiran Zhang
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
| | - Norman V Carroll
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
| | - Richard K Sterling
- Hume-Lee Transplant Center, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.,Section of Hepatology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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42
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Franco A, Balibrea N, Gimeno A, Merino E, Lopez MI, Santiago C, Perez Contreras F. Transplantation of hepatitis C infected kidneys into uninfected recipients. Why not? Nefrologia 2018; 38:672-673. [PMID: 30006233 DOI: 10.1016/j.nefro.2018.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/01/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- Antonio Franco
- Servicio de Nefrología, Hospital General Universitario Alicante, Alicante, España.
| | - Noelia Balibrea
- Servicio de Nefrología, Hospital General Universitario Alicante, Alicante, España
| | - Angelina Gimeno
- Servicio de Microbiología, Hospital General Universitario Alicante, Alicante, España
| | - Esperanza Merino
- Servicio de Medicina Interna, Hospital General Universitario Alicante, Alicante, España
| | - Maria Isabel Lopez
- Servicio de Nefrología, Hospital General Universitario Alicante, Alicante, España
| | - Carlos Santiago
- Servicio de Nefrología, Hospital General Universitario Alicante, Alicante, España
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43
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Pouteil-Noble C, Tardy JC, Chossegros P, Trepo C, Aymard M, Touraine JL. Should hepatitits-C virus antibody-positive donors be excluded from kidney donation? Transpl Int 2018. [DOI: 10.1111/tri.1992.5.s1.44] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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44
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Denewar AA, Abbas MH, Sheashaa HA, Abdelaal I, El-Dahshan K, Matter YE, Refaie AF. Detection of Hepatis C Virus-Related Immunologic Markers and Their Impact on Outcomes of Living-Donor Kidney Transplant Recipients. EXP CLIN TRANSPLANT 2018; 17:79-83. [PMID: 29957163 DOI: 10.6002/ect.2017.0161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Liver disease is an important cause of morbidity and mortality among recipients of transplanted organs. In addition to the liver, hepatitis C virus infection has a significant prevalence among recipients of kidney transplant and is related to worse graft and recipient survival as the kidney is an important component of the hepatitis C virus clinical syndrome. MATERIALS AND METHODS This retrospective single center study included 336 patients with end-stage renal disease who received a kidney transplant at the Mansoura Urology and Nephrology Center from January 1992 to December 1995. Of 336 patients, 63 were excluded, and the remaining 273 patients were divided into 3 groups: viremic active (72 patients), viremic inactive (108 patients), and nonviremic (93 patients). Division of patients was based on hepatitis C virus RNA complement level (C3 and/or C4 consumption), circulating cryoglobulins, and rheumatoid factor detection. RESULTS Our study showed insignificant differences regarding patient characteristics and demographic data among the study groups but significantly higher incidence of transaminitis in viremic (active and inactive) patients. Nonsignificant differences were found regarding proteinuria among the 3 groups, including among those who had levels in either nephrotic or nonnephrotic ranges. Biopsy-proven acute rejection episodes among the 3 groups of recipients were statistically comparable, with significantly higher frequency of chronic rejection episodes among viremic active patients. Nonviremic recipients had significantly lower serum creatinine levels than viremic (active and inactive) recipients. Patient and graft survival results were comparable among the groups. CONCLUSIONS Presence of hepatitis C virus immunologic markers does not have a significant effect on patient and graft survival; however, it may be a clue for long-term incidence of chronic rejection.
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Affiliation(s)
- Ahmed Abdelfattah Denewar
- From the Department of Dialysis and Transplantation, The Urology-Nephrology Center, Mansoura University, Mansoura, Egypt
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Abdelshahed MM, Shamah SD, Mahure SA, Mollon B, Kwon YW. Cryopreserved bone allograft for the treatment of shoulder instability with glenoid defect. J Orthop 2018; 15:248-252. [PMID: 29657478 DOI: 10.1016/j.jor.2018.01.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 01/13/2018] [Indexed: 01/26/2023] Open
Abstract
The purpose of this study was to examine outcomes after cryopreserved tri-cortical iliac crest allograft reconstruction for glenoid bone loss in patients with shoulder instability. 10 patients completed the required assessments at a mean follow up of 4.5 years. At final follow up, mean ASES was 92 ± 12, mean WOSI was 315 ± 319, with good range of motion. None of the final radiographs demonstrated graft resorption or failure of hardware. The data demonstrated that patients who were treated with glenoid bone grafting with cryopreserved tri-cortical iliac crest allograft can expect good range of motion and functional capacity.
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Affiliation(s)
- Mina M Abdelshahed
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
| | - Steven D Shamah
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
| | - Siddharth A Mahure
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
| | - Brent Mollon
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
| | - Young W Kwon
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY, USA
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Pliszczyński J, Jasztal K, Jóźwik A, Kosieradzki M, Danielewicz R, Małkowski P, Czerwiński J. Results of Renal Transplant From Deceased Anti-hepatitis C Virus Donors, Poland 1998-2012. Transplant Proc 2018; 50:1691-1696. [PMID: 30056883 DOI: 10.1016/j.transproceed.2018.02.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 02/19/2018] [Indexed: 11/25/2022]
Abstract
Kidney transplant (KTx) is the best method of renal insufficiency treatment. In dialyzed patients, mortality rises with the time on dialysis. There is a continuing shortage of organs for transplantation, hence a propensity to expand the donor pool with expanded-criteria donors, anti-hepatitis C virus-positive included. In the above case a transmission of hepatitis C virus (HCV) genotype to recipient is present. It has been proven that contamination with more than 1 HCV genotype did not worsen KTx outcomes. There are 2.6% anti-HCV(+) donors in Poland. Use is only possible in cases of anti-HCV(+) and anti-HCV RNA(+) recipients. METHODS Retrospective analysis covered 8675 deceased donors (1998-2012 Polish data from Poltransplant). The early (after 12 months) and late (after 60 months) graft and patient survival was assessed in KTx recipients, with documented recipient and donor data spanning at least 1 year after KTx. In comprehensive analysis, 7016 KTx recipients with known anti-HCV status were included according to anti-HCV profile of recipient and donor. The results are in absolute and percentage values and P < .05 assessed with χ2 test. RESULTS Twelve-month survival: recipient (R) (95%), graft (G) (89%), total; R (95% vs 89%, P < .001), G (88 vs 79, P < .001) in HCV(-) to HCV(+/-) vs HCV(+) to HCV(+); R (95 vs 94, P = .2), G (88 vs 83, P < .001), HCV(-) to HCV(-) vs HCV(-) to HCV(+); R (93 vs 95, P = .004), G (82 vs 89, P < .001) in HCV(+/-) to HCV(+) vs HCV(-) to HCV(-); R (95 vs 89, P < .001), G (88 vs 79, P < .001) in HCV(-) to HCV(-) vs HCV(+) vs HCV (+). Sixty-month survival: R (86%), G (75%), total; R (84 vs 88, P = .01), G (63 vs 71, P = .001) in HCV(+/-) to HCV(+) vs HCV(-) to HCV(-); R (88 vs 80, P = .003) in HCV(-) to HCV(-) vs HCV(+) to HCV(+). CONCLUSIONS The worst anti-HCV serological profile was HCV(+) to HCV(+), although transplanting HCV(+) to HCV(+) did not worsen outcomes in that group. Worse KTx outcomes of HCV(+) over HCV(-) donors can be attributed to HCV(+) status of the recipient.
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Affiliation(s)
- J Pliszczyński
- Department of General and Transplantation Surgery, Warsaw Medical University, Warsaw, Poland.
| | - K Jasztal
- Department of Surgical and Transplant Nursing, Warsaw Medical University, Warsaw, Poland
| | - A Jóźwik
- Department of General and Transplantation Surgery, Warsaw Medical University, Warsaw, Poland
| | - M Kosieradzki
- Department of General and Transplantation Surgery, Warsaw Medical University, Warsaw, Poland
| | - R Danielewicz
- Department of Surgical and Transplant Nursing, Warsaw Medical University, Warsaw, Poland
| | - P Małkowski
- Department of Surgical and Transplant Nursing, Warsaw Medical University, Warsaw, Poland
| | - J Czerwiński
- Department of Emergency Medicine, Warsaw Medical University, Warsaw, Poland
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Roth D, Ladino M. Transplantation of Kidneys from HCV-Positive Donors: How to Best Use a Scarce Resource. J Am Soc Nephrol 2017; 28:3139-3141. [PMID: 28874402 PMCID: PMC5661297 DOI: 10.1681/asn.2017060673] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- David Roth
- Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Marco Ladino
- Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida; and
- Nephrology Section, Miami Veterans Administration Hospital, Miami, Florida
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Colpitts CC, Chung RT, Baumert TF. Entry Inhibitors: A Perspective for Prevention of Hepatitis C Virus Infection in Organ Transplantation. ACS Infect Dis 2017; 3:620-623. [PMID: 28812869 DOI: 10.1021/acsinfecdis.7b00091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Entry inhibitors are emerging as an attractive class of therapeutics for hepatitis C virus (HCV) infection. Entry inhibitors target either virion-associated factors or cellular factors necessary for infection. By blocking entry into cells, entry inhibitors prevent both the establishment of persistent reservoirs and the emergence of resistant variants during viral replication. Furthermore, entry inhibitors protect naïve cells from virus-induced alterations. Combining entry inhibitors with direct-acting antivirals (DAAs) may therefore improve treatment outcomes, particularly in the context of organ transplantation. The role of DAAs in transplantation, while still under clinical investigation, carries the risk of recipient infection and HCV-induced disease, since DAAs act only after infection is established. Thus, entry inhibitors provide a perspective to improve patient outcomes during organ transplantation. Applying this approach for transplant of organs from HCV-positive donors to HCV-negative recipients may also contribute to alleviate the medical burden of organ shortage.
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Affiliation(s)
- Che C. Colpitts
- Inserm, U1110, Institut de Recherche
sur les Maladies Virales et Hépatiques, 3 Rue Koeberlé, 67000 Strasbourg, France
- Université de Strasbourg, 67000 Strasbourg, France
- Division of Infection
and Immunity, University College London, WC1E 6BT London, United Kingdom
| | - Raymond T. Chung
- Liver
Center and Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, United States
| | - Thomas F. Baumert
- Inserm, U1110, Institut de Recherche
sur les Maladies Virales et Hépatiques, 3 Rue Koeberlé, 67000 Strasbourg, France
- Université de Strasbourg, 67000 Strasbourg, France
- Institut
Hospitalo-Universitaire, Pôle Hépato-digestif, Hopitaux Universitaires de Strasbourg, 67000 Strasbourg, France
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Gupta G, Kang L, Yu JW, Limkemann AJ, Garcia V, Bandyopadhyay D, Kumar D, Fattah H, Levy M, Cotterell AH, Sharma A, Bhati C, Reichman T, King AL, Sterling R. Long-term outcomes and transmission rates in hepatitis C virus-positive donor to hepatitis C virus-negative kidney transplant recipients: Analysis of United States national data. Clin Transplant 2017; 31. [DOI: 10.1111/ctr.13055] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Gaurav Gupta
- Division of Nephrology; Virginia Commonwealth University; Richmond VA USA
| | - Le Kang
- Department of Biostatistics; Virginia Commonwealth University; Richmond VA USA
| | - Jonathan W. Yu
- Department of Biostatistics; Virginia Commonwealth University; Richmond VA USA
| | | | - Victoria Garcia
- Department of Biostatistics; Virginia Commonwealth University; Richmond VA USA
| | | | - Dhiren Kumar
- Division of Nephrology; Virginia Commonwealth University; Richmond VA USA
| | - Hasan Fattah
- Division of Nephrology; Virginia Commonwealth University; Richmond VA USA
| | - Marlon Levy
- Department of Surgery; Virginia Commonwealth University; Richmond VA USA
| | | | - Amit Sharma
- Department of Surgery; Virginia Commonwealth University; Richmond VA USA
| | - Chandra Bhati
- Department of Surgery; Virginia Commonwealth University; Richmond VA USA
| | - Trevor Reichman
- Department of Surgery; Virginia Commonwealth University; Richmond VA USA
| | - Anne L. King
- Division of Nephrology; Virginia Commonwealth University; Richmond VA USA
| | - Richard Sterling
- Section of Hepatology; Virginia Commonwealth University; Richmond VA USA
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50
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Ladino M, Pedraza F, Roth D. Opportunities for treatment of the hepatitis C virus-infected patient with chronic kidney disease. World J Hepatol 2017; 9:833-839. [PMID: 28740594 PMCID: PMC5504358 DOI: 10.4254/wjh.v9.i19.833] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/06/2017] [Accepted: 05/05/2017] [Indexed: 02/06/2023] Open
Abstract
The prevalence of hepatitis C virus (HCV) infection amongst patients with chronic kidney disease (CKD) and end-stage renal disease exceeds that of the general population. In addition to predisposing to the development of cirrhosis and hepatocellular carcinoma, infection with HCV has been associated with extra-hepatic complications including CKD, proteinuria, glomerulonephritis, cryoglobulinemia, increased cardiovascular risk, insulin resistance, and lymphoma. With these associated morbidities, infection with HCV is not unexpectedly accompanied by an increase in mortality in the general population as well as in patients with kidney disease. Advances in the understanding of the HCV genome have resulted in the development of direct-acting antiviral agents that can achieve much higher sustained virologic response rates than previous interferon-based protocols. The direct acting antivirals have either primarily hepatic or renal metabolism and excretion pathways. This information is particularly relevant when considering treatment in patients with reduced kidney function. In this context, some of these agents are not recommended for use in patients with a glomerular filtration rate < 30 mL/min per 1.73 m2. There are now Food and Drug Administration approved direct acting antiviral agents for the treatment of patients with kidney disease and reduced function. These agents have been demonstrated to be effective with sustained viral response rates comparable to the general population with good safety profiles. A disease that was only recently considered to be very challenging to treat in patients with kidney dysfunction is now curable with these medications.
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