The New Direct Antiviral Agents and Hepatitis C in Thoracic Transplantation: Impact on Donors and Recipients

Robert L Gottlieb, Shelley A Hall, Robert L Gottlieb, Shelley A Hall

Abstract

Purpose of review: The landscape of abdominal organ transplantation has been altered by the emergence of curative direct-acting antiviral agents for hepatitis C. Expansion of the thoracic donor pool to include the hearts and the lungs from hepatitis C-positive donors holds promise to increase available donor organs.

Recent findings: Case reports have documented separate lung and heart transplant patients who acquired, and then were cured of, donor-derived hepatitis C using these newer, more effective therapies. Single sites and national consortia are underway to help make this approach part of the standard-of-care. Pangenotypic therapies may simplify the paradigm.

Summary: Organs from donors with active hepatitis C viremia are likely suitable for transplant as long as the organ is otherwise acceptable. Best-practices for "informed-risk" transplant include a team-based approach and a selection of the antiviral regimen based on insurer's formulary, potential drug interactions, and genotype.

Keywords: Direct-acting antiviral; Donor shortage; Heart transplant; Hepatitis C; Lung transplant; Organ allocation.

Conflict of interest statement

Compliance with Ethical StandardsRobert Gottlieb reports participation in the National Consortium Trial, TROJAN-C (Transplant of Redeemed Organs by Judicious Administration of New Direct-Acting Antivirals for Hepatitis C Heart Recipients, NCT03383419). TROJAN-C is receiving pharmaceutical supplies from Gilead Pharmaceuticals, USA. This investigator-initiated trial is sponsored independently by Baylor Scott & White Research Institute. Gilead is not the study sponsor, is not responsible for either the conduct or the design of the trial, and is providing the study drug only. This relationship is disclosed as a potential conflict of interest nonetheless. Shelley Hall reports non-financial support from Gilead, outside the submitted work.All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

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Source: PubMed

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