Treatment of Hepatitis C in Solid Organ Transplantation

The impact of infection and tissue damage in solid-organ transplantation

Investigations over the past two decades are revealing complexities in the regulation of the innate immune response, and how this response, in turn, controls adaptive immunity. Microbial exposure, infections and tissue damage that accompany solid-organ transplantation result in the release of pathogen- and damage-associated molecular patterns, as well as pathogen- or allograft-derived antigens. Here, we review these triggers of innate and adaptive immunity, and discuss emerging paradigms of the many ways in which infections and tissue damage might directly or indirectly affect alloreactivity and the outcome of transplanted allografts.

Treatment of hepatitis C in potential lung transplant candidates

International guidelines list hepatitis C virus (HCV) as a contraindication to lung transplant (LTx). Since the development of these guidelines, the natural history of HCV after nonhepatic transplant has been clarified, and more effective antiviral therapy is available. In renal transplant candidates, HCV treatment before transplantation improves posttransplant outcome. There are no data regarding the safety and efficacy of HCV therapy in LTx candidates. We describe the outcomes of HCV treatment in five LTx candidates. Three have had a sustained virologic response and there have been no unexpected adverse effects. Two have gone on to LTx. We conclude that selected lung transplant candidates can safely and effectively be treated for HCV before transplantation. An approach to selecting HCV-positive LTx candidates for antiviral therapy and transplant listing using clinical, virologic, and histologic data is described based on this experience and current knowledge regarding HCV natural history after solid organ transplant.

Can Donors With Prior Hepatitis Be Safely Used for Heart Transplantation?

BACKGROUND

Heart transplantation represents a significant life-saving and increased quality-of-life intervention for patients with refractory cardiac failure. Successful transplantation requires continuous immunosuppression to avoid immune rejection. Unfortunately, persistent viral infections in donors may be transmitted to recipients in the process of heart transplantation. With the severe shortage of available organs and significant waiting list mortality there is a rationale for considering use of organs from donors with evidence of prior hepatitis B and/or hepatitis C infection.

METHODS

Published literature articles were searched using Medline, PaperChase and further review of references in relevant articles on issues related to hepatitis B and hepatitis C and heart transplantation.

RESULTS

Donor and recipient testing for hepatitis B and hepatitis C is important for relative risk assessment. Nucleic acid testing for hepatitis B DNA and hepatitis C RNA represent emerging technologies, which may add valuable information to traditional serologic testing.

CONCLUSIONS

Heart transplant recipient risk may be modified by vaccination against hepatitis B before transplantation. There is currently no available vaccine for hepatitis C. Recently described effective treatments for hepatitis B and hepatitis C provide further rationale for reconsideration of using hearts from donors with evidence of hepatitis B and/or hepatitis C infection.