Cardiac transplantation from non-viremic hepatitis C donors

Abstract

Background: Hepatitis C (HCV) donors are rarely used for cardiac transplantation due to historically poor outcomes. In 2015, nucleic acid testing (NAT) for viral load was added to the routine work-up of organ donors, allowing for the distinction between subjects who remain viremic (HCV Ab⁺/NAT⁺) and those who have cleared HCV and are no longer viremic (HCV Ab⁺/NAT^-). The American Society of Transplantation recently recommended that HCV Ab⁺/NAT^- donors be considered non-infectious and safe for transplantation. We present our initial experience with such donors.

Methods: All patients were counseled regarding donor HCV antibody (Ab) and NAT. Transplant recipients were tested post-transplant at 1 week and at 1, 3, and 6 months for HCV seropositivity and viremia. We also analyzed the UNOS database to determine the potential impact of widespread acceptance of HCV Ab⁺/NAT^- organs.

Results: Fourteen HCV Ab^‒ subjects received hearts from HCV Ab⁺/NAT^- donors in 2017. Over a median follow-up of 256 (192 to 377) days, 3 patients developed a reactive HCV Ab, yet none had a detectable HCV viral load during prospective monitoring at any time. Analysis of the UNOS database for the calendar year 2016 revealed that only 7 (3%) of 220 HCV Ab⁺/NAT^- donors were accepted for heart transplantation.

Conclusions: We have demonstrated the feasibility of utilizing HCV Ab⁺/NAT^- donors for cardiac transplantation without recipient infection. A small percentage of recipients developed HCV Ab without evidence of viremia, possibly consistent with a biological false reactive test, as has been seen in other settings. Large-scale validation of our data may have a significant impact on transplantation rates.

Keywords: heart transplant; hepatitis C; immunsupression; nucleic acid testing; viremia.