Long‐term follow‐up of acute and chronic rejection in heart transplant recipients from hepatitis C viremic (NAT+) donors

• Published in: American journal of transplantation Vol. 22; no. 12; pp. 2951 - 2960
• Main Authors: Stachel, Maxine W., Alimi, Marjan, Narula, Navneet, Flattery, Erin E., Xia, Yuhe, Ramachandran, Abhinay, Saraon, Tajinderpal, Smith, Deane, Reyentovich, Alex, Goldberg, Randal, Kadosh, Bernard S., Razzouk, Louai, Katz, Stuart, Moazami, Nader, Gidea, Claudia G.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01.12.2022
• Subjects: clinical research/practice; Donors; donors and donation: donor‐derived infections; Follow-Up Studies; Graft rejection; graft survival; Heart; heart (allograft) function/dysfunction; Heart transplantation; Heart Transplantation - adverse effects; heart transplantation/cardiology; Heart transplants; Hepacivirus; Hepatitis; Hepatitis C; Humans; immunosuppression/immune modulation; infection and infectious agents ‐ viral: hepatitis C; Mortality; Prospective Studies; rejection; Statistical analysis; Tissue Donors; Transplant Recipients; Transplants & implants; Vascular diseases; Viremia; Viremia - etiology; heart (allograft) function/dysfunction; immunosuppression/immune modulation; clinical research/practice; donors and donation: donor-derived infections; infection and infectious agents - viral: hepatitis C; graft survival; heart transplantation/cardiology; rejection
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.17190

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. A prospective study comparing patients who received heart transplants from hepatitis C viremic and non‐viremic donors finds no differences in acute or chronic rejection, graft dysfunction or mortality.