Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX USA.
Center for Advanced Heart and Lung Disease, Baylor University Medical Center, 3410 Worth Street, Suite 250, Dallas, TX 75246 USA.
Department of Internal Medicine, Texas A&M Health Science Center, Dallas, TX USA.
PURPOSE OF REVIEW:
The landscape of abdominal organ transplantation has been altered by the emergence of curative direct-acting antiviral agents for hepatitis C. Expansion of the thoracic donor pool to include the hearts and the lungs from hepatitis C-positive donors holds promise to increase available donor organs.
Case reports have documented separate lung and heart transplant patients who acquired, and then were cured of, donor-derived hepatitis C using these newer, more effective therapies. Single sites and national consortia are underway to help make this approach part of the standard-of-care. Pangenotypic therapies may simplify the paradigm.
Organs from donors with active hepatitis C viremia are likely suitable for transplant as long as the organ is otherwise acceptable. Best-practices for "informed-risk" transplant include a team-based approach and a selection of the antiviral regimen based on insurer's formulary, potential drug interactions, and genotype.