Incidence of Pancreatitis in Recipients of Hepatitis C Donor Hearts

Abstract

Purpose Using hearts from hepatitis C (HCV) donors is a potential strategy to address organ shortage and extended waiting times in those listed for heart transplantation (HT). We report two cases of pancreatitis in patients who received hearts from HCV donors at our institution. Methods Between September 2016 and October 2018, 49 patients underwent HT using hearts from donors with active HCV viremia at time of organ recovery. All patients were treated with standard immunosuppression. Data collection and analysis were performed after obtaining informed patient consent and IRB approval. Results Forty-six of 49 patients (94%) developed HCV infection post-HT, including 2 patients who developed signs of hemorrhagic, necrotizing pancreatitis prior to initiation of HCV treatment with direct-acting antiviral (DAA) therapies. Work-up for alternative causes of acute pancreatitis was unremarkable and, in both patients, pancreatitis resolved with initiation of HCV treatment. HCV viremia was associated with increased levels of C-reactive protein (CRP) (median (IQR) 46 mg/ L (20-106) and ferritin (median (IQR) 355 ng/ mL (204-693) suggesting an inflammatory response. Conclusion Recipients of hearts from HCV donors have promising long-term outcomes. However, we report two cases of hemorrhagic pancreatitis that developed in patients with HCV infection prior to therapy with DAAs. Further studies are needed to elucidate the potential association between HCV infection in immunosuppressed hosts, and acute pancreatitis.