1 Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FL.
2 Department of Transplant Hepatology, Duke University, Durham, NC.
3 Department of Transplant, Cleveland Clinic, Cleveland, OH.
4 Department of Transplant, Cleveland Clinic Florida, Weston, FL.
5 Department of Internal Medicine, Cleveland Clinic, Weston, FL.
INTRODUCTION: Hepatitis C virus (HCV) viremic organs are underutilized and there is limited real-world experience on the transplantation of HCV viremic solid organs into HCV negative recipients.
METHODS: Patients listed or being evaluated for solid organ transplant after January 26, 2018 were educated and consented by protocol on the transplantation of HCV viremic organs. All recipients were HCV nucleic acid test (NAT) and anti-HCV antibody negative at the time of transplant and received an HCV viremic organ. The primary outcome was sustained virologic response at 12 weeks after completion of DAA therapy (SVR12 ).
RESULTS: Seventy-five HCV negative patients underwent solid organ transplantation from an HCV viremic donor. No patients had evidence of advanced hepatic fibrosis. Treatment regimen and duration were at the discretion of the hepatologist. Sixty-four patients underwent KT and 58 KT recipients had either started or completed DAA therapy. Forty-one achieved SVR12 , 10 had undetectable viral loads but are not eligible for SVR12 and 7 remain on treatment. One KT recipient was a non-responder due to NS5A resistance. Four patients underwent liver transplant and 2 underwent liver-kidney transplant. Three patients achieved SVR12 , 1 has completed DAA therapy, and 2 remain on treatment. Seven patients underwent heart transplant and 1 underwent heart-kidney transplant. Six patents achieved SVR12 and 2 patients remain on treatment.
CONCLUSION: Limited data exists on the transplantation of HCV viremic organs into HCV negative recipients. Our study is the largest to describe a real-world experience of the transplantation of HCV viremic organs into aviremic recipients. In carefully selected patients, the use of HCV viremic grafts in the DAA era appears to be efficacious and well tolerated.