Hep C hearts safe for transplant, study says

Hepatitis C-positive donor hearts are a viable long-term option for patients in need of a heart transplant, researchers confirmed in JAMA Cardiology Dec. 18.

Hep C itself—a virus-derived infection that attacks the liver and causes inflammation—is known to hike a patient’s risk of CVD by as much as 28%, according to a Lancet analysis published earlier this year. The same study found that hepatitis C-linked heart disease is responsible for 1.5 million lost disability-adjusted life years (DALYs) annually.

The number of hepatitis C-infected organ donors has increased exponentially in the U.S. over the past few years, coinciding with the rapid rise of the opioid epidemic. These donors are typically considered high-risk and, though we now have access to effective, direct-acting antivirals to combat hep C, many patients shy away from accepting an infected donor heart.

“Previous experience using hepatitis C virus (HCV)-positive donors was a high rate of HCV infection and unacceptably poor outcomes in recipients,” Kelly H. Schlendorf, MD, and colleagues wrote in JAMA. “However, since the introduction of direct-acting antivirals that have a high cure rate for HCV, there is renewed interest in using organs from HCV-positive donors as a strategy to expand the donor pool. This is particularly crucial given the increase in drug overdose as a cause of donor death and rising rates of HCV infection in users of intravenous drugs.”

Schlendorf and her team undertook a prospective, single-center observational study of 80 adults who underwent heart transplants using hep C-infected hearts between September 2016 and April 2019. The authors said researchers have reported favorable early outcomes for some patients implanted with HCV-infected hearts, but little is known about the longer-term impacts of such an undertaking.

Schlendorf et al.’s study population was 71.3% men and, on average, in their mid-fifties. Patients who consented to receiving a hep C-positive heart—defined as a heart that tested positive for hepatitis C antibody and/or nucleic acid—received a transplant within an average of four days. Of donors who tested positive for hep C, 70 had viremia and 10 were seropositive but didn’t have viremia.

The authors reported that no recipients of donors with negative nucleic acid testing results developed donor-derived hepatitis C. Of the 70 patients who did receive donor hearts with positive nucleic acid testing results, 67 (95.7%) developed donor-derived hep C over an average of 301 days. However, treatment with antivirals was well-tolerated and successful in all patients.

One-year survival for patients who did pick up an infection during transplant was 90.4%—a number that wasn’t much different from the survival rate for patients who underwent transplant with a hep C-free donor heart.

“At a time when the discrepancy between organ supply and organ demand continues to increase, our findings suggest that use of these donors is an effective way to increase the donor pool, thereby increasing transplant volumes and reducing the morbidity and mortality of patients awaiting heart transplantation,” the authors wrote. “Further work is needed to illuminate longer-term outcomes...to guide the optimal timing and duration of HCV treatment and better inform wait-listed patients and their clinicians as they consider this option.”

The United Network for Organ Sharing estimated there were 1,631 hepatitis C-positive organ transplants in the U.S. during the first 10 months of 2018. Earlier this year, when he was told he needed a heart transplant, Robert Montgomery, MD, the director of NYU Langone Health’s Transplant Institute, opted to receive a donor heart from a heroin user who’d died of a drug overdose. Montgomery contracted hep C from the donor but, with eight weeks of oral medication, the infection cleared.