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Leeaphorn N, Attieh RM, Wadei HM, Mao SA, Mao MA, Pungpapong S, Taner B, Cheungpasitporn W, Jarmi T. Regional Differences and Temporal Changes in the Utilization of HCV-Viremic Donors in Kidney Transplantation. Transplant Proc 2024; 56:1513-1521. [PMID: 38997885 DOI: 10.1016/j.transproceed.2024.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/20/2024] [Indexed: 07/14/2024]
Abstract
INTRODUCTION Despite the data demonstrating an increased utilization of hepatitis C virus (HCV)-viremic kidneys, the acceptance and incorporation of HCV-viremic kidneys are not universal. We aimed to identify regional differences and their temporal changes in the utilization of HCV-viremic kidneys. METHODS Using the Organ Procurement and Transplantation Network database, HCV-viremic kidneys utilized in kidney transplants from March 15, 2019, to March 14, 2023, were included. The utilization of HCV-viremic kidneys across the United States and center-level clustering of HCV-viremic donor kidney transplants into HCV NAT-negative recipients (HCV D+/R- transplants) using Gini coefficients were examined. RESULTS Significant regional variations were observed, with regions 3, 10, and 11 accounting for 51% of all HCV-viremic kidney utilization. Region 9 benefited the most from HCV-viremic kidney transplants with a high influx of kidney imports from other regions (284.9% gain). Region 8 and region 6 encountered the most substantial losses, with net losses of -44.2% and -41.1%, respectively. HCV D+/R- transplants were concentrated in specific high-volume centers, but trends indicated a gradual increase in a more equitable distribution across centers over time. CONCLUSIONS Significant variations can be observed in the utilization of HCV-viremic kidneys throughout the United States. These variations highlight opportunities for kidney transplant centers in specific regions to adopt policies for HCV-viremic kidney transplants, thereby expanding their donor pool. Encouragingly, an increasing number of kidney transplant centers are adopting HCV D+/R- kidney transplants, indicating positive progress. These trends suggest a more balanced access to HCV-viremic kidneys ahead.
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Affiliation(s)
- Napat Leeaphorn
- Department of Transplant, Mayo Clinic, Jacksonville, Florida, USA.
| | - Rose Mary Attieh
- Department of Transplant, Mayo Clinic, Jacksonville, Florida, USA
| | - Hani M Wadei
- Department of Transplant, Mayo Clinic, Jacksonville, Florida, USA
| | - Shennen A Mao
- Department of Transplant, Mayo Clinic, Jacksonville, Florida, USA
| | - Michael A Mao
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Burcin Taner
- Department of Transplant, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Tambi Jarmi
- Department of Transplant, Mayo Clinic, Jacksonville, Florida, USA
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Paneitz DC, Wolfe SB, Giao D, Tessier SN, Dageforde LA, Elias N, Rabi SA, Michel E, D’Alessandro DA, Osho AA. The Public Health Service "Increased Risk" 2020 Policy Change Has not Improved Organ Utilization in the United States: A Nationwide Cohort Study. ANNALS OF SURGERY OPEN 2024; 5:e368. [PMID: 38883934 PMCID: PMC11175935 DOI: 10.1097/as9.0000000000000368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/20/2023] [Indexed: 06/18/2024] Open
Abstract
Objective To assess the effects of the 2020 United States Public Health Service (PHS) "Increased Risk" Guidelines update. Background Donors labeled as "Increased Risk" for transmission of infectious diseases have been found to have decreased organ utilization rates despite no significant impact on recipient survival. Recently, the PHS provided an updated guideline focused on "Increased Risk" organ donors, which included the removal of the "Increased Risk" label and the elimination of the separate informed consent form, although the actual increased risk status of donors is still ultimately transmitted to transplant physicians. We sought to analyze the effect of this update on organ utilization rates. Methods This was a retrospective analysis of the Organ Procurement and Transplantation Network database which compared donor organ utilization in the 2 years before the June 2020 PHS Guideline update for increased-risk donor organs (June 2018-May 2020) versus the 2 years after the update (August 2020-July 2022). The organ utilization rate for each donor was determined by dividing the number of organs transplanted by the total number of organs available for procurement. Student t test and multivariable logistic regression models were used for analysis. Results There were 17,272 donors in the preupdate cohort and 17,922 donors in the postupdate cohort; of these, 4,977 (28.8%) and 3,893 (21.7%) donors were considered "Increased Risk", respectively. There was a 2% decrease in overall organ utilization rates after the update, driven by a 3% decrease in liver utilization rates and a 2% decrease in lung utilization rates. After multivariable adjustment, donors in the postupdate cohort had 10% decreased odds of having all organs transplanted. Conclusions The 2020 PHS "Increased Risk" Donor Guideline update was not associated with an increase in organ utilization rates in the first 2 years after its implementation, despite a decrease in the proportion of donors considered to be at higher risk. Further efforts to educate the community on the safe usage of high-risk organs are needed and may increase organ utilization.
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Affiliation(s)
- Dane C. Paneitz
- From the Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Stanley B. Wolfe
- From the Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Duc Giao
- From the Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Shannon N. Tessier
- Department of Surgery, Center for Engineering in Medicine & Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Leigh Anne Dageforde
- Division of Abdominal Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Nahel Elias
- Division of Abdominal Transplantation, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Seyed Alireza Rabi
- From the Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Eriberto Michel
- From the Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - David A. D’Alessandro
- From the Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Asishana A. Osho
- From the Department of Surgery, Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Nunez M, Kelkar AA. Hepatitis C and heart transplantation: An update. Clin Transplant 2023; 37:e15111. [PMID: 37650430 DOI: 10.1111/ctr.15111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023]
Abstract
There are limited data regarding heart transplantation in the setting of hepatitis C virus (HCV) infection in either recipients or donors, as the practice was infrequent, given concerns of worse post-transplant outcomes. This changed dramatically after the development of highly effective HCV therapies, namely direct-acting antivirals (DAAs). Additionally, nucleic acid testing currently in use establishes more precisely the risk of HCV transmission from donors. As a result, chronic HCV infection in itself is no longer a barrier for heart transplant candidates, and the use of HCV-positive organs for HCV-infected and non-infected transplant candidates has increased dramatically. A review of the literature revealed that in the pre-DAA era, HCV seropositive heart transplant patients had a higher mortality than their seronegative counterparts. However, short-term data suggest that the differences in survival have been erased in the DAA era. Heart transplantation from HCV-viremic donors to HCV-uninfected recipients has become increasingly common as the number of deceased donors with HCV viremia has increased over the past years. Preliminary outcome reports are very encouraging, although further data are needed with regard to long-term safety. New information continues to be incorporated to optimize protocols that guide this practice.
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Affiliation(s)
- Marina Nunez
- Department of Internal Medicine, Section on Infectious Diseases, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, North Carolina, USA
| | - Anita A Kelkar
- U.S. Department of Veterans Affairs, Kernersville VA Health Care System, Kernesville, North Carolina, USA
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Clinical outcomes of heart transplantation using hepatitis c-viremic donors: a systematic review with meta-analysis. J Heart Lung Transplant 2022; 41:538-549. [DOI: 10.1016/j.healun.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 11/18/2022] Open
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Siddiqi HK, Schlendorf KH. Hepatitis C Positive Organ Donation in Heart Transplantation. CURRENT TRANSPLANTATION REPORTS 2021; 8:359-367. [PMID: 34786324 PMCID: PMC8579730 DOI: 10.1007/s40472-021-00350-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 01/05/2023]
Abstract
Purpose of Review To summarize outcomes to date, as well as important considerations and unanswered questions related to the use of hepatitis C virus (HCV) positive donors for heart transplantation. Recent Findings Outcomes from single-center studies and registry data to date suggest that among patients who develop donor-transmitted HCV after heart transplantation, direct-acting antiviral therapies (DAAT) are effective and well-tolerated, and that short-term survival is similar to that of patients transplanted with HCV - donors. Summary In an era marked by increasing numbers of HCV positive deceased donors and a growing imbalance between the demand and supply of donor hearts, utilization of HCV + donors is a feasible strategy to expand the donor pool and reduce waitlist times. Ongoing work is needed to clarify longer-term outcomes with the use of this strategy.
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Affiliation(s)
- Hasan K Siddiqi
- Division of Cardiology, Vanderbilt University Medical Center, 1215 21, St Avenue South, Suite 5307, Nashville, TN 37232 USA
| | - Kelly H Schlendorf
- Division of Cardiology, Vanderbilt University Medical Center, 1215 21, St Avenue South, Suite 5307, Nashville, TN 37232 USA
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Copeland H, Baran DA. Predicting the future: Hepatitis C donors in focus. J Heart Lung Transplant 2021; 41:48-49. [PMID: 34802878 DOI: 10.1016/j.healun.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hannah Copeland
- Division of Cardiac Surgery, Heart Transplant and Mechanical Circulatory Support Lutheran Hospital, Fort Wayne, Indiana; Indiana University School of Medicine - Fort Wayne (IUSM-FW), Fort Wayne, Indiana.
| | - David A Baran
- Division of Heart Failure, Heart Transplant, and Cardiology, Sentara Heart Hospital, Norfolk, Virginia
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Stewart ZA, Shah SA, Rolls JA, Guarrera JV, Kandaswamy R, Axelrod DA. Best practice recommendations for the use of hepatitis C viremic donor organs for hepatitis C virus naïve recipients. Clin Transplant 2021; 35:e14381. [PMID: 34086371 DOI: 10.1111/ctr.14381] [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: 12/12/2020] [Revised: 04/22/2021] [Accepted: 05/25/2021] [Indexed: 11/28/2022]
Abstract
The combination of the transplant organ deficit, the increase in HCV nucleic acid positive donors (HCV NAT+), and the development of direct-acting antiviral agents (DAAs) has resulted in a rapid increase in HCV NAT+ organ transplants into HCV naïve recipients. Early clinical experience with HCV NAT+ donor organs has shown promising outcomes; however, best practices are lacking to guide transplant programs during all phases of patient care. Transplant programs developing protocols for the utilization of HCV NAT+ organs will need a multidisciplinary team to address all aspects of pre-transplant and post-transplant patient care. Reports of fibrosing cholestatic hepatitis in HCV NAT+ organ transplant recipients receiving delayed DAA initiation highlight the need for the transplant community to develop safe and effective protocols. A failure to do so will inevitably lead to the erosion of public trust from cases of missed or inadequately treated donor-derived HCV infections. Herein, we provide best practice guidelines for the utilization of HCV NAT+ organs into HCV-negative recipients based on literature review and expert opinion from the faculty of the ASTS Standards and Quality Committee.
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Affiliation(s)
- Zoe A Stewart
- Transplant Institute, NYU Langone Health, New York, NY, USA
| | - Shimul A Shah
- Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Jason A Rolls
- Division of Transplantation, Christiana Hospital, Newark, DE, USA
| | - James V Guarrera
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Raja Kandaswamy
- Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - David A Axelrod
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Prakash K, Aslam S. New updates in the world of hepatitis C virus infected organ transplantation. Curr Opin Organ Transplant 2021; 25:364-370. [PMID: 32520787 DOI: 10.1097/mot.0000000000000785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW With the advent of direct acting antiviral (DAA) therapy, the use of organs from hepatitis C virus infected (HCV+) donors is gaining more traction. In this review, we aim to: provide an overview of recent literature that supports the use of HCV+ organs, outline ongoing challenges to the use of these organs, and highlight the areas within this field where active investigation is ongoing. RECENT FINDINGS The present review describes clinical outcomes related to the transplantation of both HCV+ nonviremic and viremic organs and the distinction between hepatic and nonhepatic transplants. It also discusses the current debate pertaining to the ideal treatment strategy for donor-derived HCV infection, that is pre-emptive therapy versus prophylaxis therapy. SUMMARY Data suggest that the use of HCV+ organs is an effective and relatively well tolerated strategy to combat the organ scarcity. However, clinicians must be vigilant to a signal of increased inflammation as HCV+ organ transplantation becomes more universal. Recent studies suggest that shorter courses of DAA may sufficiently treat donor-derived HCV infection, however the best treatment approach to minimize risk, cost, and toxicity is still under investigation.
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Affiliation(s)
- Katya Prakash
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA
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