Key result
Heart transplantation involving HCV-positive donors or recipients has encouraging short-term survival in the direct-acting antiviral era, erasing historical mortality differences.
Why the study?
Heart transplantation involving HCV infection in recipients or donors was historically infrequent due to concerns over post-transplant outcomes, but direct-acting antivirals and improved nucleic acid testing have dramatically shifted clinical practice.
Does the use of direct-acting antivirals and HCV-positive organs affect post-transplant survival in heart transplant recipients?
Does the use of direct-acting antivirals and HCV-positive organs affect post-transplant survival in heart transplant recipients?
The advent of direct-acting antivirals has made chronic HCV infection no longer a barrier for heart transplantation and enabled the safe use of HCV-positive donor organs.
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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Núñez et al. (2023) conducted a review in Hepatitis C virus (HCV) infection and heart transplantation. Heart transplantation involving HCV-positive donors or recipients in the direct-acting antiviral (DAA) era vs. Pre-DAA era / HCV-negative counterparts was evaluated. Heart transplantation involving HCV-positive donors or recipients has encouraging short-term survival in the direct-acting antiviral era, erasing historical mortality differences.
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