Clinical outcomes of heart transplantation using hepatitis c-viremic donors: A systematic review with meta-analysis

Abstract

Background: Heart transplantation (HTx) from hepatitis C virus (HCV)-viremic donors to nonviremic recipients decreases mortality and costs. Consequently, many transplant centers have reported their results using this strategy. Hence, there is a need for an outcome analysis.

Methods: We performed a systematic review with meta-analysis. In August 2020, we searched PubMed and EMBASE for publications containing data of nonviremic recipients who underwent HTx from HCV-viremic donors once direct-acting antiviral (DAA) therapy had become available (≥2014).

Results: We identified 398 publications, 13 of which met inclusion criteria, and analyzed the outcomes of 195 recipients. The HCV-transmission rate was >97% but, the cure rate was 100% with DAA therapy. The 6 and 12-month survival were 95.6% and 92.9%, respectively. Of 10 deaths reported, none were associated with HCV infection. The acute cellular rejection (ACR) rate was 31.1%. The overall DAA failure rate was 1.1%, defined as the need to alter the initial DAA therapy due to failure to cure HCV. However, the DAA failure rate was 0% when the DAA therapy was started within the first 2 weeks post-HTx. No statistically significant differences in HCV cure rates, survivals, ACR rates, and DAA failure rates were observed when outcomes were stratified by therapeutic approach type (i.e., a prophylactic approach in which DAA was given to the recipient before confirming HCV-transmission vs a reactive approach, in which DAA was given to the recipient only after an HCV-transmission was confirmed).

Conclusions: Excellent clinical outcomes have been observed in nonviremic recipients of HTx from HCV-viremic donors since DAA had become available.

Keywords: cardiac transplantation; direct-acting antivirals; heart transplantation; hepatitis c non-viremic recipients; hepatitis c viremic donors; hepatitis c virus; nucleic acid amplification test.