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Outcomes in Hepatitis C (HCV) Viremic Grafts to HCV Negative Recipients in Heart Transplantation: A Multicenter Study of Differing Treatment Strategies

K. Ryland1, B. Aqel2, D. Steidley2, P. Patel1, S. Pungpapong3

1Mayo Clinic, Jacksonville, FL, 2Mayo Clinic, Phoenix, AZ, 3Mayo Clinic College of Medicine, Jacksonville, FL

Meeting: 2022 American Transplant Congress

Abstract number: 1651

Keywords: Allocation, Heart transplant patients, Hepatitis C, Infection

Topic: Clinical Science » Infection Disease » 27 - Non-Organ Specific: Viral Hepatitis

Session Information

Session Name: Non-Organ Specific: Viral Hepatitis

Session Type: Poster Abstract

Date: Tuesday, June 7, 2022

Session Time: 7:00pm-8:00pm

 Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

*Purpose: Using HCV viremic grafts for heart transplantation (HT) improves donor supply and shortens wait times. However, treatment strategies are variable post-transplant. This study aims to evaluate outcomes from multiple treatment regimens at two centers in the United States.

*Methods: This is a retrospective review of the outcomes of HT recipients of HCV viremic grafts from 2019 – 2021.

*Results: At Center 1, 13 patients underwent HT from HCV positive donors. These were 12 men, 1 woman, 10 Caucasians, 2 African-Americans and 1 Hispanic. Median recipient age was 59 years. 4 patients were treated preemptively per a study protocol with glecaprevir/pibrentasvir (G/P) and ezetimibe, 1 dose prior to surgery followed by 7 days of therapy. 9 patients were treated reactively starting at a median of 4 days after transplant with baseline median peak viral load of 5,690 IU/mL. 7 patients received G/P for 12 weeks, and 2 patients received G/P for 8 weeks. All patients achieved sustained virological response (SVR). Median time to HT was 1.7 months compared with 3.7 months for the region and 6.2 months for the United States. 8 patients had mild acute cellular rejection in their post-transplant course to date, 1 had antibody-mediated rejection and 1 had CMV viremia. Average ejection fraction (EF) on echocardiogram was 61.5% on most recent follow up ranging from 4 months to 28 months post-transplant. At Center 2, 11 patients underwent HT from HCV positive donors. There were 8 men, 3 women, 9 Caucasians and 2 African-Americans. Median age was 64 years old. 1 patient did not become viremic post-transplant. All viremic patients were treated reactively with sofosbuvir/velpatasvir (S/V) for 12 weeks (6 patients), G/P for 8 weeks (1 patient), or G/P for 12 weeks (4 patients) per insurance preference. Treatment started at a median of 29.5 days after transplant with baseline median peak viral load of 8,210,000 IU/mL. All patients achieved SVR. Median time to HT was 2.1 months compared with 7.3 months for the region. Each patient had 1 or more episodes of mild acute rejection on biopsy with 1 patient having moderate acute rejection to date. 1 patient had CMV viremia. Average EF on echocardiogram was 61.8% on most recent follow up ranging from 9 months to 27 months post-transplant. 1 patient died of non-transplant related causes.

*Conclusions: Despite various treatment regimens and strategies, all patients were cured of hepatitis C, had reduced time on the waiting list and had similar post-transplant cardiac function.

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To cite this abstract in AMA style:

Ryland K, Aqel B, Steidley D, Patel P, Pungpapong S. Outcomes in Hepatitis C (HCV) Viremic Grafts to HCV Negative Recipients in Heart Transplantation: A Multicenter Study of Differing Treatment Strategies [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-in-hepatitis-c-hcv-viremic-grafts-to-hcv-negative-recipients-in-heart-transplantation-a-multicenter-study-of-differing-treatment-strategies/. Accessed May 30, 2025.

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