Should We Continue Wasting Hearts? Outcomes of Heart Transplantation From Hepatitis C Donors: A Systematic Literature Review

Abstract

Background The number of patients dying awaiting heart transplantation (HT) can be reduced through HT from Hepatitis C nucleic acid test positive donors (HCV+D) to negative recipients (HCV-R). This strategy remains underused. Objective Analyze the outcomes of HT from HCV+D to HCV-R, of several transplant centers in the era of direct-acting antiviral therapy (DAA). Methods We searched for literature published from January 2015 to April 2020 with “Hepatitis C Virus” & “Heart Transplantation” as keywords. Results We identified 195 HT from HCV+D to HCV-R, done in 12 centers, reported as part of clinical studies, case reports, or case series. There were no deaths reported due to HCV infection in recipients of HCV+D and their survivals at 1, 6, and 12 months were 96.2, 93.2, and 89.3 percent, respectively (table 1). Sustained virologic response at 12 weeks (SVR-12) was achieved in all cases where the data were available. HCV was transmitted via HT to 97.6% of the reported subjects, and all with viremia received DAA. DAA was started after identifying viremia (delayed strategy) in 10 centers, and in 2 of them preemptively (immediately after HT). DAA duration was intended for 12 weeks in the delayed regimen, and 4 in the preemptive, with no difference in SVR-12. Within the preemptive regimen, no changes or extension of DAA were reported, while 5 subjects in the delayed regimen required either changes or extensions (to 24 weeks) of the initial DAA. Conclusions HCV is highly contagious via HT. Current DAA provides an excellent cure rate, with all cases reported to date achieving SVR-12. For those under a preemptive regimen, no changes or extension in DAA were required. Recipients of hearts from HCV+D had an excellent survival, and no deaths related to HCV were reported.