Medical teams at the Vanderbilt Transplant Center (VTC) are leading the way in utilization of hepatitis C-exposed donors for heart transplantation.
What was once an unthinkable practice — taking hearts from hepatitis C-infected donors to transplant noninfected recipients — is now gaining traction among the heart transplant community. The reason? While older treatments for hepatitis C were poorly tolerated and unsafe for heart transplant recipients, newer, direct-acting antiviral therapies are both safe and well tolerated, with excellent cure rates even in immunosuppressed patients.
According to Kelly Schlendorf, MD, MHS, assistant professor of Medicine and medical director of the Adult Heart Transplant Program at Vanderbilt, “hearts from these donors, most of whom are young and, sadly, die from complications associated with intravenous drug use, tend to be of excellent quality.”
These hearts, which were previously being discarded due to the donor’s hepatitis C infection, “offer a novel strategy to expand the donor pool, especially for those patients on the waiting list who may otherwise die before a suitable organ becomes available,” she said.
Schlendorf and her colleagues have reported their preliminary outcomes at national and international meetings, as well as in the June 2018 issue of The Journal of Heart and Lung Transplantation.
“This is a hot topic in the heart transplant community right now, and Vanderbilt is leading the way.”
Since fall 2016, Vanderbilt has transplanted more than 44 patients with hearts from hepatitis C-exposed donors, representing the largest experience of any transplant center to date.
“The success of the program is due in large part to the amazing collaboration and support provided by our liver transplant colleagues, without whom we couldn’t make this happen,” Schlendorf said.
The practice of hepatitis C-donor positive to recipient negative transplantation has been utilized within the transplant liver program since the development of the direct-acting antiviral therapies.
“Other programs have watched us closely. With our experience and success, we have been able to integrate our programs, and have a major impact on organ availability. The new treatments for hepatitis C have allowed an entire group of potential donors to actually donate. That has really changed the paradigm of transplantation,” said Roman Perri, MD, medical director of the Adult Liver Transplant Program at VUMC.
The Medical Center has established protocols for these transplant recipients, which includes testing immediately following transplantation to check for virus levels and extensive education of patients and their families, according to Perri. Heart transplant recipients who go on to develop hepatitis C infection are treated with antiviral therapies under the supervision of a team of liver transplant physicians, nurses and pharmacists, among others.
An estimated 3.5 million people in the United States are living with hepatitis C infection, a number that is on the rise in the setting of the growing opioid epidemic.
“From something as devastating as the death of a loved one due to IV drug abuse, perhaps something good may come,” said Schlendorf. “Our program and our patients are grateful to the families of these donors for recognizing that potential good.”
