Vanderbilt leads use of hepatitis C-exposed donors for patients awaiting heart transplants

 
 

What was once an unthinkable practice — taking hearts from hepatitis C-infected donors to transplant noninfected recipients — is gaining traction among transplant centers and saving lives of those who would otherwise die waiting on a new heart.

The reason? While older treatments for hepatitis C were poorly tolerated and unsafe for heart transplant recipients, newer, direct-acting antiviral therapies are both safe and well tolerated, with excellent cure rates even in immunosuppressed patients.

“Hearts from these donors, most of whom are young and, sadly, die from complications associated with intravenous drug use, tend to be of excellent quality,” said Kelly Schlendorf, M.D., MHS, assistant professor of Medicine and medical director of the Adult Heart Transplant Program at Vanderbilt. These hearts, which were previously being discarded due to the donor’s hepatitis C infection, “offer a novel strategy to expand the donor pool, especially for those patients on the waiting list who may otherwise die before a suitable organ becomes available.”

Since fall 2016, Vanderbilt has transplanted more than 80 patients with hearts from hepatitis C-exposed donors, representing the largest experience of any heart transplant center to date. Heart transplant recipients who receive the hearts and develop hepatitis C infection are treated with antiviral therapies under the supervision of a team of transplant physicians, nurses and pharmacists, among others.

Schlendorf and her colleagues have reported their preliminary outcomes at national and international meetings, as well as in the June 2018 issue of The Journal of Heart and Lung Transplantation.

“Vanderbilt is one of the top two busiest heart transplant programs in the country, and we have an obligation not only to take care of our patients – which has always been our first and foremost priority and will continue to be – but to also advance the field of transplant through innovation and research and technology,” Schlendorf said. “What makes Vanderbilt such a special place is that the institution is committed to research and innovation, and our use of these hepatitis C hearts is a great example of that. Vanderbilt is leading the way.”

An estimated 3.5 million people in the United States are living with hepatitis C infection, a number that is on the rise as the opioid epidemic grows.

“From something as devastating as the death of a loved one due to IV drug abuse, perhaps something good may come,” said Schlendorf. “Our program and our patients are grateful to the families of these donors for recognizing that potential good.”

This story was adapted from a VUMC Reporter story by Jessica Pasley.