BACKGROUND

National data demonstrate that increasing opportunities exist for organ donation among hepatitis C virus (HCV)–infected individuals.

METHODS

We developed a clinical practice protocol for the acceptance of HCV+ organs for HCV- patients who underwent heart transplantation (HT) and retrospectively reviewed the outcomes at our institution. Inclusion criteria were as follows: all adult patients listed for HT. Exclusion criteria were as follows: pre-existing HIV or active hepatitis B viremia in the recipient/donor.

RESULTS

We transplanted 21 patients from HCV+ donors. Nineteen were viremic donors, and 2 were non-viremic donors. The recipients included 18 patients who underwent HT alone, and 3 patients who underwent combined heart-kidney transplants. There was no HCV transmission from the non-viremic donors (n = 2). All 19 recipients of the viremic donors developed HCV infection (100% transmission). The median age of the viremic donors was 34 years (interquartile range 30–46), and 84.2% were considered US Public Health Service–increased risk. Induction immunosuppression consisted of anti-thymocyte globulin (7/21), basiliximab (7/21), or none (8/21). Maintenance immunosuppression comprised tacrolimus, mycophenolate mofetil, and prednisone. Post-operative Week 2 HCV viral load was not related to induction. Direct anti-viral agent (DAA) therapy for a 12-week course consisted of glecaprevir/pibrentasvir (14/19, 74%), sofosbuvir/velpatasvir (2/19, 11%), elbasvir/grazoprevir (2/19, 11%), and ledipasvir/sofosbuvir (1/19, 5%). All the patients on DAA therapy cleared viremia. The sustained virological response rate at 12 weeks in 18 evaluable patients was 100%.

CONCLUSIONS

We report successful single-center experience using HCV+ organs for HT into HCV- recipients. We believe that there is utility in using such organs to expand the current donor pool. Further long-term follow-up is needed.

中文翻译：

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来自丙型肝炎病毒阳性供体的心脏移植结果。

背景

国家数据表明，在感染丙型肝炎病毒（HCV）的个体中器官捐赠的机会越来越多。

方法

我们为接受心脏移植（HT）的HCV-患者制定了接受HCV +器官的临床实践方案，并回顾了我们机构的结果。纳入标准如下：所有成年HT患者。排除标准如下：接受者/供者中预先存在艾滋病毒或活动性乙型肝炎病毒血症。

结果

我们移植了HCV +供体的21例患者。19个是病毒血症的供体，2个是非病毒血症的供体。接受者包括18例仅接受HT的患者和3例接受了心脏-肾脏移植的患者。非病毒血症捐助者未传播HCV（n = 2）。病毒血症供体的所有19位接受者均出现了HCV感染（100％传播）。病毒性供体的中位年龄为34岁（四分位间距为30-46），并且84.2％被认为是美国公共卫生服务部门增加的风险。诱导免疫抑制由抗胸腺细胞球蛋白（7/21），巴利昔单抗（7/21）或无（8/21）组成。维持性免疫抑制包括他克莫司，霉酚酸酯和泼尼松。术后第2周HCV病毒载量与诱导无关。12周疗程的直接抗病毒药物（DAA）疗法包括格列卡韦/哌布那韦（14/19，74％），索非布韦/韦帕他韦（2/19，11％），依巴斯韦/格拉佐韦（2/19，11） ％）和ledipasvir / sofosbuvir（1/19，5％）。所有接受DAA治疗的患者均清除了病毒血症。18名可评估患者在12周时的持续病毒学应答率为100％。

结论

我们报告了将HCV +器官用于HT的HCV-受体成功的单中心经验。我们认为利用这些器官来扩大目前的捐助者库是有用的。需要进一步的长期随访。