Magnitude of Recipient Viremia after Heart Transplantation from HCV Viremic Donors and Time to Clearance with Therapy

Abstract

Purpose Due to advances in curative therapy for Hepatitis C infection, hearts from hepatitis C viremic (HCV) donors were successfully transplanted in selected patients. We assessed the relationship between the magnitude of recipient and time to HCV viremia clearance after transplantation. Methods From January until October 2018, 12 patients received heart transplantation from donors with active HCV viremia. All recipients developed viremia within one week and were treated with glecaprevir/pibrentasvir (Mavyret) for a duration of 8 weeks. HCV viral load was monitored weekly by real-time PCR. Results The mean age was 60 ± 8years, 33% were females, and 9 patients had non-ischemic cardiomyopathy (75%). All recipients (100%) had detectable HCV viremia at 1-week post heart transplant; the lowest detectable viral load was 1. 36 log IU/ml and the highest was 7.06 log IU/ml, with a mean of 4.47 ± 2.13 log IU/ml (ref range 1.18 - 8 log IU/mL). Complete clearance of HCV viremia varied from 1 to 6 weeks with a mean of 2.8 ± 2.1 weeks. There was an association between the level of initial viremia and time to viral load clearance (Fig). At an average of 147 ± 88 days follow up, HCV viral load was undetectable in all patients. Forty percent of patients developed hepatitis C antibodies. There was no correlation between the level of initial viremia, duration of viremia clearance, genotype status and antibody response. Conclusion Heart transplantation from donors with active hepatitis C is safe with rapid clearance of viremia in all exposed patients. Time to viral clearance is related to initial viremic load. A sustained antibody response did not develop in all patients. This may be related to immunosuppression or relatively low level and duration of viremia.