Impact of Transplanting Hepatitis C Nucleic Acid Testing Positive (NAT+) Donors to Hepatitis C Virus NAT- Cardiothoracic Recipients

Abstract

<h3>Purpose</h3> The purpose of this study is to assess the clinical impact of utilizing HCV NAT+ donors in aviremic heart (HT) and lung (LT) transplant recipients. <h3>Methods</h3> A single-center, retrospective chart review was conducted on patients who received a HT or LT between 4/1/19-5/27/20. HCV antibody - and NAT- recipients of a HCV NAT+ graft were included in the analysis. <h3>Results</h3> Nineteen HCV NAT- patients underwent cardiothoracic transplantation (CT) with a HCV NAT+ organ (10 HT and 9 LT) and were included for evaluation; 47.4% male, average age 58 ± 7.9 years, 73.7% white. HCV transmission occurred in 100% of recipients. Average time to direct acting antiviral (DAA) initiation was 46 ± 20.7 days after transplant. SVR12 was achieved in 93.3% (14/15; 4 patients have not completed 12-week follow up post DAA completion). Treatment failure occurred in 1 LT patient with P32del mutation on glecaprevir/pibrentasvir, requiring alternative therapy (sofosbuvir/velpatasvir/voxilaprevir and ribavirin). 84.2% of patients developed post-transplant liver dysfunction. No patients developed fibrosing cholestatic hepatitis. Two patients died, 1 due to anastomotic complication (LT) and 1 due to pulmonary embolism (HT). De novo donor specific antibodies were present in 1 HT and 2 LT recipients, developing 4 days and a median of 137.5 (56-219) days post-transplant, respectively. Clinically significant rejection was identified and treated in 1 HT patient (ACR2). No episodes of rejection were identified in LT recipients. Five patients (26.3%) had documented DAA related adverse effects, including gastrointestinal, fatigue, orthostatic hypotension, and nail discoloration. <h3>Conclusion</h3> A high SVR12 rate was achieved in HCV NAT donor +/recipient - CT, who were initiated on DAA therapy after insurance approval. These results are reflective of real-word experience for patients not included in clinical trials. Few reported clinically significant episodes of rejection or DAA adverse effects occurred.