Rational Heart Transplant From a Hepatitis C Donor: New Antiviral Weapons Conquer the Trojan Horse

Robert L. Gottlieb, Teena Sam, Suzanne Y Wada, James F. Trotter, Sumeet K. Asrani, Brian Lima, Susan M. Joseph, Gonzalo V. Gonzalez-Stawinski, Shelley A. Hall

Research output: Contribution to journalArticle

12 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)765-767
Number of pages3
JournalJournal of Cardiac Failure
Volume23
Issue number10
DOIs
StatePublished - Oct 1 2017
Externally publishedYes

Fingerprint

Weapons
Hepatitis C
Antiviral Agents
Tissue Donors
Transplants
Viremia
Heart Transplantation
Therapeutics
Genotype
Pharmaceutical Economics
Viral Load
Transplantation
Infection

Keywords

  • Hepatitis C
  • orthotopic heart transplantation donor allocation
  • pangenotypic
  • velpatasvir-sofosbuvir (Epclusa)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Rational Heart Transplant From a Hepatitis C Donor : New Antiviral Weapons Conquer the Trojan Horse. / Gottlieb, Robert L.; Sam, Teena; Wada, Suzanne Y; Trotter, James F.; Asrani, Sumeet K.; Lima, Brian; Joseph, Susan M.; Gonzalez-Stawinski, Gonzalo V.; Hall, Shelley A.

In: Journal of Cardiac Failure, Vol. 23, No. 10, 01.10.2017, p. 765-767.

Research output: Contribution to journalArticle

Gottlieb, RL, Sam, T, Wada, SY, Trotter, JF, Asrani, SK, Lima, B, Joseph, SM, Gonzalez-Stawinski, GV & Hall, SA 2017, 'Rational Heart Transplant From a Hepatitis C Donor: New Antiviral Weapons Conquer the Trojan Horse', Journal of Cardiac Failure, vol. 23, no. 10, pp. 765-767. https://doi.org/10.1016/j.cardfail.2017.08.448
Gottlieb, Robert L. ; Sam, Teena ; Wada, Suzanne Y ; Trotter, James F. ; Asrani, Sumeet K. ; Lima, Brian ; Joseph, Susan M. ; Gonzalez-Stawinski, Gonzalo V. ; Hall, Shelley A. / Rational Heart Transplant From a Hepatitis C Donor : New Antiviral Weapons Conquer the Trojan Horse. In: Journal of Cardiac Failure. 2017 ; Vol. 23, No. 10. pp. 765-767.
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AB - 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.

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