Clinical Experience with Heart Transplantation from Hepatitis C Positive Donors

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Purpose Advances in cure for active hepatitis C (HCV) have prompted consideration of HCV positive donors to address the continued shortage of organs. We have offered the option to accept HCV + donors, without any donor restrictions, to all patients on the waiting list. Methods From January to October 2018, 25 patients were transplanted, 12 patients from HCV viremic donors (NAT+). All recipients were seronegative at the time of transplantation. All patients were consented to receive an HCV donor as part of an IRB study. Survival and natural history of viral transmission and treatment were evaluated. Results 25 patients were transplanted with a mean age of 57 ± 12years, 28% females and 11 were blood type O (44%). All the recipients from HCV NAT + donors developed hep C viremia at 1-week postransplant. Therapy with glecaprevir/pibrentasvir (Mavyret) was initiated once seroconversion was established for duration of 8 weeks. All patients received standard triple immunotherapy. The HCV viremia cleared at a mean of 2.8 ± 2.1 weeks after initiation of therapy with a sustained viremic response at last follow up. There were no differences in early rejection rate or grade between patients receiving hearts from viremic versus non viremic donors. There were no significant abnormalities of liver function tests in patients with viremia. The shortest time on the waiting list was 3 days and the longest time was 197 days with a mean of 62 days. Eight recipients (32%) waited less than one month. At a mean follow up of 147 ± 88 days there was 100% graft and patient survival in both groups with no PGD. Conclusion While experience continues to grow, heart transplantation from donors with active hepatitis C is safe with excellent short term survival and rapid clearance of viremia. All patients develop viremia and respond to current antiviral therapy. These hearts represent an important potential resource from an underutilized donor pool and should be considered for transplantation. Long-term follow up is necessary.