In DAA Era, Could HCV-Infected Hearts Be Viable for Transplant?

Preemptive direct-acting antiviral (DAA) therapy helps prevent chronic hepatitis C virus (HCV) infection in HCV-negative cardiac transplant candidates who opt to receive an HCV-infected heart, according to new findings presented at the Liver Meeting.

Because HCV-infected donor hearts have typically been discarded in the past, these results could have important future implications for these organs’ viability for transplant and for transplantation wait times.

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The preliminary findings emerged from an ongoing single-center, proof-of-concept trial conducted by Emily Bethea, MD, fellow of the Liver Center and GI Division at Massachusetts General Hospital, and colleagues.

So far, the findings have been promising: all patients who have undergone transplant with an HCV-positive donor heart have achieved viral suppression with undetectable or nonquantifiable HCV RNA by day 7.

“With the rising HCV incidence and growing number of HCV‐positive donors, there is a time sensitive and critical need to document both efficacy and detailed logistics surrounding successful use of HCV‐positive organs,” the authors of the study wrote.

“This strategy has the potential to decrease heart transplant wait times and improve post‐transplant outcomes,” they added.

The study enrolled 25 patients whose status on a cardiac transplantation wait list was updated to reflect their willingness to receive an HCV-positive heart. So far, 16 have received an HCV-positive donor heart, all of whom have achieved viral suppression and demonstrated undetectable HCV RNA in all tests performed after initial viral suppression.

Encouragingly, over 1740 days of cumulative follow-up, cardiac allograft and patient survival were 100%. Of note, no drug-related side effects or interactions and no treatment failures have been reported.

In this cohort, transplanting HCV-positive hearts into HCV-negative donors was also shown to reduce time to transplant due to their willingness to accept an HCV-positive donor heart. As heart failure prevalence has continually increased in the United States while the number of annual transplants has remained largely unchanged, these data shed light on HCV-infected hearts as valuable and underutilized potential resources.

—Christina Vogt

Reference:

Bethea E, Lewis G, Gaj K, et al. Preemptive pan-genotypic direct acting antiviral therapy in donor HCV-positive to recipient HCV-negative cardiac transplantation. Hepatology. 2018;68(S1). https://doi.org/10.1002/hep.30256.