Robert L Gottlieb1, Teena Sam2, Suzanne Y Wada3, James F Trotter4, Sumeet K Asrani4, Brian Lima5, Susan M Joseph6, Gonzalo V Gonzalez-Stawinski5, Shelley A Hall6. 1. Baylor University Medical Center, Dallas, Texas; Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas; Baylor Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas; Department of Internal Medicine, Texas A&M Health Science Center, Dallas, Texas. Electronic address: robert.gottlieb@bswhealth.org. 2. Baylor University Medical Center, Dallas, Texas; Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas; Baylor Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas. 3. Baylor University Medical Center, Dallas, Texas; Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas; North Texas Infectious Disease Consultants, Dallas, Texas. 4. Baylor University Medical Center, Dallas, Texas; Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas; Liver Consultants of Dallas, Dallas, Texas. 5. Baylor University Medical Center, Dallas, Texas; Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas; Baylor Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas; Department of Cardiac and Thoracic Surgery, Baylor University Medical Center, Dallas, Texas. 6. Baylor University Medical Center, Dallas, Texas; Baylor Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas; Baylor Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas; Department of Internal Medicine, Texas A&M Health Science Center, Dallas, Texas.
Abstract
BACKGROUND: Donors with hepatitis C (HCV) viremia are rarely used for orthotopic heart transplantation (HT) owing to post-transplantation risks. New highly effective HCV antivirals may alter the landscape. METHODS: An adult patient unsuitable for bridging mechanical support therapy accepted a heart transplant offer from a donor with HCV viremia. On daily logarithmic rise in HCV viral load and adequate titers to ensure successful genotyping, once daily sofosbuvir (400 mg)-velpatasvir (100 mg) (Epclusa; Gilead) was initiated empirically pending HCV genotype (genotype 3a confirmed after initiation of therapy). RESULTS: We report the kinetics of acute hepatitis C viremia and therapeutic response to treatment with a new pangenotypic antiviral agent after donor-derived acute HCV infection transmitted incidentally with successful cardiac transplantation to an HCV-negative recipient. Prompt resolution of viremia was noted by the 1st week of a 12 week course of antiviral therapy. Sustained virologic remission continued beyond 12 weeks after completion of HCV therapy (SVR-12). CONCLUSIONS: The availability of effective pangenotypic therapy for HCV may expand donor availability. The feasibility of early versus late treatment of HCV remains to be determined through formalized protocols. We hypothesize pharmacoeconomics to be the greatest limitation to widespread availability of this promising tool.
BACKGROUND: Donors with hepatitis C (HCV) viremia are rarely used for orthotopic heart transplantation (HT) owing to post-transplantation risks. New highly effective HCV antivirals may alter the landscape. METHODS: An adult patient unsuitable for bridging mechanical support therapy accepted a heart transplant offer from a donor with HCV viremia. On daily logarithmic rise in HCV viral load and adequate titers to ensure successful genotyping, once daily sofosbuvir (400 mg)-velpatasvir (100 mg) (Epclusa; Gilead) was initiated empirically pending HCV genotype (genotype 3a confirmed after initiation of therapy). RESULTS: We report the kinetics of acute hepatitis C viremia and therapeutic response to treatment with a new pangenotypic antiviral agent after donor-derived acute HCV infection transmitted incidentally with successful cardiac transplantation to an HCV-negative recipient. Prompt resolution of viremia was noted by the 1st week of a 12 week course of antiviral therapy. Sustained virologic remission continued beyond 12 weeks after completion of HCV therapy (SVR-12). CONCLUSIONS: The availability of effective pangenotypic therapy for HCV may expand donor availability. The feasibility of early versus late treatment of HCV remains to be determined through formalized protocols. We hypothesize pharmacoeconomics to be the greatest limitation to widespread availability of this promising tool.
Authors: Meghan E Sise; Ian A Strohbehn; Emily Bethea; Jenna L Gustafson; Raymond T Chung Journal: Curr Opin Organ Transplant Date: 2019-06 Impact factor: 2.640
Authors: Schnegg Bruno; Bart Nicole; Dharan Nila J; Matthews Gail; Nadel James; Macdonald Peter S; Hayward Christopher S Journal: Transplant Direct Date: 2019-08-23