Clinical outcomes of heart transplantation using hepatitis c-viremic donors: A systematic review with meta-analysis

• Published in: The Journal of heart and lung transplantation Vol. 41; no. 4; pp. 538 - 549
• Main Authors: Villegas-Galaviz, Josue, Anderson, Eve, Guglin, Maya
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2022
• Subjects: Antiviral Agents - therapeutic use; cardiac transplantation; direct-acting antivirals; Heart Transplantation; Hepacivirus; Hepatitis C - drug therapy; hepatitis c non-viremic recipients; hepatitis c viremic donors; hepatitis c virus; Hepatitis C, Chronic - drug therapy; Humans; nucleic acid amplification test; Tissue Donors; hepatitis c viremic donors; NAT; heart transplantation; hepatitis c non-viremic recipients; DAA; cardiac transplantation; SVR12; HTx; ISHLT; NAT+Ds; direct-acting antivirals; ACR; hepatitis c virus; NAT-Rs; HCV; IPD; nucleic acid amplification test
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2022.01.010

Heart transplantation (HTx) from hepatitis C virus (HCV)-viremic donors to nonviremic recipients decreases mortality and costs. Consequently, many transplant centers have reported their results using this strategy. Hence, there is a need for an outcome analysis. We performed a systematic review with meta-analysis. In August 2020, we searched PubMed and EMBASE for publications containing data of nonviremic recipients who underwent HTx from HCV-viremic donors once direct-acting antiviral (DAA) therapy had become available (≥2014). We identified 398 publications, 13 of which met inclusion criteria, and analyzed the outcomes of 195 recipients. The HCV-transmission rate was >97% but, the cure rate was 100% with DAA therapy. The 6 and 12-month survival were 95.6% and 92.9%, respectively. Of 10 deaths reported, none were associated with HCV infection. The acute cellular rejection (ACR) rate was 31.1%. The overall DAA failure rate was 1.1%, defined as the need to alter the initial DAA therapy due to failure to cure HCV. However, the DAA failure rate was 0% when the DAA therapy was started within the first 2 weeks post-HTx. No statistically significant differences in HCV cure rates, survivals, ACR rates, and DAA failure rates were observed when outcomes were stratified by therapeutic approach type (i.e., a prophylactic approach in which DAA was given to the recipient before confirming HCV-transmission vs a reactive approach, in which DAA was given to the recipient only after an HCV-transmission was confirmed). Excellent clinical outcomes have been observed in nonviremic recipients of HTx from HCV-viremic donors since DAA had become available.