- HCV-positive hearts and lungs can be safely transplanted into HCV-negative recipients with excellent cure rates and graft outcomes after 4 weeks of sofosbuvir/velpatasvir (Epclusa).
Why this matters
- Use of HCV-infected organs can expand the donor pool, reduce time to transplantation.
- Accompanying editorial calls early results encouraging but says "there is still a lot to learn,” noting limited long-term data, particularly for cardiovascular safety.
- DONATE HCV trial of 44 HCV-mismatched heart (n=8) and lung (n=36) transplants from 41 donors, Brigham and Women’s Hospital.
- 4-week course of sofosbuvir/velpatasvir started a few hours posttransplant.
- Primary outcome: composite, sustained virologic response at 12 weeks posttherapy (SVR12) and 6-month graft survival.
- Funding: Mendez National Institute of Transplantation Foundation; others.
- Median donor viral load, 890,000 (interquartile range [IQR], 276,000-4.63 million) IU/mL.
- Genotypes included HCV-1 (61%), HCV-2 (17%), HCV-3 (17%), indeterminate (5%).
- Immediately posttransplant, 42 patients (95%) had detectable viral load (median, 1800 [IQR, 800-6180] IU/mL).
- All 35 patients with 6-month data achieved composite endpoint with excellent graft function.
- Viral load became and stayed undetectable after 2 weeks.
- At 1 year: graft survival in 15/16 patients; 1 heart transplant recipient died at 8 months from unrelated disseminated infection.
- Monocentric design.
- Small sample.