Long-term follow-up of acute and chronic rejection in heart transplant recipients from hepatitis C viremic (NAT+) donors
© 2022 The American Society of Transplantation and the American Society of Transplant Surgeons..
The long-term safety of heart transplants from hepatitis C viremic (NAT+) donors remains uncertain. We conducted a prospective study of all patients who underwent heart transplantation at our center from January 2018 through August 2020. Routine testing was performed to assess for donor-derived cell-free DNA, acute cellular rejection (ACR), antibody-mediated rejection (AMR), and cardiac allograft vasculopathy (CAV). Allograft dysfunction and mortality were also monitored. Seventy-five NAT- recipients and 32 NAT+ recipients were enrolled in the study. All NAT+ recipients developed viremia detected by PCR, were treated with glecaprevir/pibrentasvir at the time of viremia detection, and cleared the virus by 59 days post-transplant. Patients who underwent NAT testing starting on post-operative day 7 (NAT+ Group 1) had significantly higher viral loads and were viremic for a longer period compared with patients tested on post-operative day 1 (NAT+ Group 2). Through 3.5 years of follow-up, there were no statistically significant differences in timing, severity, or frequency of ACR in NAT+ recipients compared with the NAT- cohort, nor were there differences in noninvasive measures of graft injury, incidence or severity of CAV, graft dysfunction, or mortality. There were five episodes of AMR, all in the NAT- group. There were no statistically significant differences between Group 1 and Group 2 NAT+ cohorts. Overall, these findings underscore the safety of heart transplantation from NAT+ donors.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:22 |
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| Enthalten in: |
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons - 22(2022), 12 vom: 26. Dez., Seite 2951-2960 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Stachel, Maxine W [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 08.12.2022 Date Revised 24.01.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/ajt.17190 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM345709187 |
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| 520 | |a © 2022 The American Society of Transplantation and the American Society of Transplant Surgeons. | ||
| 520 | |a The long-term safety of heart transplants from hepatitis C viremic (NAT+) donors remains uncertain. We conducted a prospective study of all patients who underwent heart transplantation at our center from January 2018 through August 2020. Routine testing was performed to assess for donor-derived cell-free DNA, acute cellular rejection (ACR), antibody-mediated rejection (AMR), and cardiac allograft vasculopathy (CAV). Allograft dysfunction and mortality were also monitored. Seventy-five NAT- recipients and 32 NAT+ recipients were enrolled in the study. All NAT+ recipients developed viremia detected by PCR, were treated with glecaprevir/pibrentasvir at the time of viremia detection, and cleared the virus by 59 days post-transplant. Patients who underwent NAT testing starting on post-operative day 7 (NAT+ Group 1) had significantly higher viral loads and were viremic for a longer period compared with patients tested on post-operative day 1 (NAT+ Group 2). Through 3.5 years of follow-up, there were no statistically significant differences in timing, severity, or frequency of ACR in NAT+ recipients compared with the NAT- cohort, nor were there differences in noninvasive measures of graft injury, incidence or severity of CAV, graft dysfunction, or mortality. There were five episodes of AMR, all in the NAT- group. There were no statistically significant differences between Group 1 and Group 2 NAT+ cohorts. Overall, these findings underscore the safety of heart transplantation from NAT+ donors | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a clinical research/practice | |
| 650 | 4 | |a donors and donation: donor-derived infections | |
| 650 | 4 | |a graft survival | |
| 650 | 4 | |a heart (allograft) function/dysfunction | |
| 650 | 4 | |a heart transplantation/cardiology | |
| 650 | 4 | |a immunosuppression/immune modulation | |
| 650 | 4 | |a infection and infectious agents - viral: hepatitis C | |
| 650 | 4 | |a rejection | |
| 700 | 1 | |a Alimi, Marjan |e verfasserin |4 aut | |
| 700 | 1 | |a Narula, Navneet |e verfasserin |4 aut | |
| 700 | 1 | |a Flattery, Erin E |e verfasserin |4 aut | |
| 700 | 1 | |a Xia, Yuhe |e verfasserin |4 aut | |
| 700 | 1 | |a Ramachandran, Abhinay |e verfasserin |4 aut | |
| 700 | 1 | |a Saraon, Tajinderpal |e verfasserin |4 aut | |
| 700 | 1 | |a Smith, Deane |e verfasserin |4 aut | |
| 700 | 1 | |a Reyentovich, Alex |e verfasserin |4 aut | |
| 700 | 1 | |a Goldberg, Randal |e verfasserin |4 aut | |
| 700 | 1 | |a Kadosh, Bernard S |e verfasserin |4 aut | |
| 700 | 1 | |a Razzouk, Louai |e verfasserin |4 aut | |
| 700 | 1 | |a Katz, Stuart |e verfasserin |4 aut | |
| 700 | 1 | |a Moazami, Nader |e verfasserin |4 aut | |
| 700 | 1 | |a Gidea, Claudia G |e verfasserin |4 aut | |
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