Cardiac transplantation from non-viremic hepatitis C donors
Copyright © 2018 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2018 |
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| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:37 |
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| Enthalten in: |
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation - 37(2018), 10 vom: 19. Okt., Seite 1254-1260 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Patel, Snehal R [VerfasserIn] |
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| Links: |
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| Themen: |
Heart transplant |
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| Anmerkungen: |
Date Completed 27.01.2020 Date Revised 27.01.2020 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.healun.2018.06.012 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM287654311 |
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| 100 | 1 | |a Patel, Snehal R |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Cardiac transplantation from non-viremic hepatitis C donors |
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| 500 | |a Date Revised 27.01.2020 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2018 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
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| 700 | 1 | |a Saeed, Omar |e verfasserin |4 aut | |
| 700 | 1 | |a Sims, Daniel B |e verfasserin |4 aut | |
| 700 | 1 | |a Shin, J Julia |e verfasserin |4 aut | |
| 700 | 1 | |a Nucci, Cecilia |e verfasserin |4 aut | |
| 700 | 1 | |a Borukhov, Edward |e verfasserin |4 aut | |
| 700 | 1 | |a Goldstein, Doctor Y |e verfasserin |4 aut | |
| 700 | 1 | |a Jakobleff, William |e verfasserin |4 aut | |
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| 700 | 1 | |a Goldstein, Daniel J |e verfasserin |4 aut | |
| 700 | 1 | |a Jorde, Ulrich P |e verfasserin |4 aut | |
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