Hepatitis C Patients Expand Heart Donor Pool

Hepatitis C remains a debilitating condition. This contagious liver disease, caused by a virus, affects 71 million people worldwide according to the latest WHO figures. Because of its contagion, health personnel take measures with people infected with hepatitis C, especially when it comes to transplants. However, according to a study by the medical center at Vanderbilt University (USA) and published in the journal Jama Cardiology, heart transplants for hepatitis C patients would be possible and would work well.

For the researchers, the results of patients who received hearts from donors positive for hepatitis C were comparable to those of patients who received hearts from donors without the disease. With this discovery, it will then be possible to offer many more hearts to people awaiting a transplant.

Before the effectiveness of direct-acting antiviral therapies was proven, the hearts of hepatitis C carriers were sidelined. Thanks to the latest scientific developments, the donor pool is enlarged, reducing the waiting time and thus reducing the mortality of patients waiting for an appropriate organ.

Hearts as good as the rest

For this study, the researchers followed 80 adult patients at the Vanderbilt University medical center. These patients had received heart transplants from hepatitis C positive donors between September 2016 and May 2019.

The Vanderbilt Transplant Center is considered to be the largest user of hepatitis C positive donor organs in the world. Since 2016, it has increased the use of these hearts for patients due to the established effectiveness of direct acting antiviral therapies, which can cure hepatitis C infection in 12 weeks.

Kelly Schlendorf, lead author of the study and medical director of the adult heart transplant program at Vanderbilt University Medical Center, says the therapies have minimal side effects. She has observed an increase in the volume of heart transplants in the United States, which she attributes, at least in part, to transplants using hepatitis C positive donors.

“These donors offer a strategy to safely expand the donor pool while allowing more patients to have a transplant. When you consider the alternative, it’s a big deal, ”says Kelly Schlendorf.

Vanderbilt University doubled the number of heart transplants, from 130 between 2013 and 2015 to 260 between 2016 and 2018. During this period, 37% of heart transplants came from donors who are positive for hepatitis C. This has contributed to the improvement of the figures for heart transplant cases.

A shortened waiting list

The time spent on waiting lists decreases with the availability of more organs. Among the patients who participated in the study, the wait time for those who agreed to receive a hepatitis C positive heart was only four days, compared to an average wait time of 70 to 535 days for other recipients in the country.

“Reducing wait times has reduced the need for prolonged mechanical circulatory support, and has reduced the risk of complications such as kidney failure, infection, stroke and death, rejoices Kelly Schlendorf. The longer a patient has to wait, the higher the risk of death. ”

Donor hearts positive for hepatitis C became common after the United States was confronted with the opioid crisis, marked by many deaths from drug overdose. “This is probably the only bright spot in an otherwise tragic epidemic,” says Kelly Schlendorf. Transplant centers located in regions where the opioid crisis is less severe may not benefit as much as we do. However, more needs to be done to monitor long-term results. ”

Previously, a research team led by Dr. Ann Woolley of the Brigham and Women’s Hospital in Boston, said that the use of hepatitis C positive donor organs could increase the supply of hearts and lungs by at least minus 25%.

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