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Hepatitis c and organ donor

Peter P Reese, Peter L Abt, Emily A Blumberg, Vivianna M Van Deerlin, Roy D Bloom, Vishnu S Potluri, Matthew Levine, Paige Porrett, Deirdre Sawinski, Susanna M Nazarian, Ali Naji, Richard Hasz, Lawrence Suplee, Jennifer Trofe-Clark, Anna Sicilia, Maureen McCauley, Caren Gentile, Jennifer Smith, Bijan A Niknam, Melissa Bleicher, K Rajender Reddy, David S Goldberg
Background: Organs from hepatitis C virus (HCV)-infected deceased donors are often discarded. Preliminary data from 2 small trials, including THINKER-1 (Transplanting Hepatitis C kidneys Into Negative KidnEy Recipients), suggested that HCV-infected kidneys could be safely transplanted into HCV-negative patients. However, intermediate-term data on quality of life and renal function are needed to counsel patients about risk. Objective: To describe 12-month HCV treatment outcomes, estimated glomerular filtration rate (eGFR), and quality of life for the 10 kidney recipients in THINKER-1 and 6-month data on 10 additional recipients...
August 7, 2018: Annals of Internal Medicine
Daniel R Kaul, Susan M Tlusty, Marian G Michaels, Ajit P Limaye, Cameron R Wolfe
The opioid epidemic has resulted in a potential increase in donors in the testing window period for hepatitis C virus (HCV). We analyzed HCV reports to the Disease Transmission Advisory Committee (DTAC) between 2008 and 2016 to estimate the risk of HCV transmission. In 15 of 95 (16%) reports, at least one recipient developed proven/ probable donor-derived HCV resulting in 32 infected recipients. Seven transmissions occurred during the nucleic acid testing (NAT) window period; 4 occurred during serological window period...
August 6, 2018: Clinical Transplantation
Gaurav Gupta, Yiran Zhang, Norman V Carroll, Richard K Sterling
Pilot studies suggest that transplanting Hepatitis C (HCV) positive donor (D+) kidneys into HCV negative renal transplant (RT) recipients (R-), then treating HCV with direct acting anti-virals (DAA) is clinically feasible. To determine if this is a cost-effective approach, a decision tree model was developed to analyze costs and effectiveness over a 5-year time frame between two choices: RT using a D+/R- strategy compared to continuing dialysis and waiting for a HCV negative donor (D-/R-). The strategy of accepting a HCV+ organ then treating HCV was slightly more effective and substantially less expensive and resulted in an expected 4...
August 3, 2018: American Journal of Transplantation
Yuri L Boteon, Richard W Laing, Andrea Schlegel, Loraine Wallace, Amanda Smith, Joseph Attard, Ricky H Bhogal, Desley Ah Neil, Stefan Hübscher, M Thamara Pr Perera, Darius F Mirza, Simon C Afford, Hynek Mergental
BACKGROUND: Hypothermic oxygenated perfusion and normothermic perfusion are seen as distinct techniques of ex-situ machine perfusion of the liver. We aimed to demonstrate the feasibility of combining both techniques and whether it would improve functional parameters of donor livers into transplant standards. METHODS: Ten discarded human donor livers had either 6 hours of normothermic perfusion (n=5) or 2 hours of hypothermic oxygenated perfusion followed by 4 hours of normothermic perfusion (n=5)...
July 30, 2018: Liver Transplantation
J Pliszczyński, K Jasztal, A Jóźwik, M Kosieradzki, R Danielewicz, P Małkowski, J Czerwiński
Kidney transplant (KTx) is the best method of renal insufficiency treatment. In dialyzed patients, mortality rises with the time on dialysis. There is a continuing shortage of organs for transplantation, hence a propensity to expand the donor pool with expanded-criteria donors, anti-hepatitis C virus-positive included. In the above case a transmission of hepatitis C virus (HCV) genotype to recipient is present. It has been proven that contamination with more than 1 HCV genotype did not worsen KTx outcomes. There are 2...
July 2018: Transplantation Proceedings
Claudio Velati, Luisa Romanò, Vanessa Piccinini, Giuseppe Marano, Liviana Catalano, Simonetta Pupella, Giuseppina Facco, Ilaria Pati, Maria Elena Tosti, Stefania Vaglio, Giuliano Grazzini, Alessandro Zanetti, Giancarlo M Liumbruno
BACKGROUND: In Italy nucleic acid testing (NAT) became mandatory for hepatitis C virus (HCV) in 2002 and for human immunodeficiency virus (HIV) and hepatitis B virus in 2008. The aim of this study was to monitor the incidence and prevalence of HIV and HCV infections in Italian blood donors and the current residual risk of these infections after the introduction of NAT. MATERIALS AND METHODS: The Italian national blood surveillance system includes data from tests used to screen for transfusion-transmissible infections...
June 26, 2018: Blood Transfusion, Trasfusione del Sangue
Andrew A Li, George Cholankeril, Xingxing S Cheng, Jane C Tan, Donghee Kim, Alice E Toll, Satheesh Nair, Aijaz Ahmed
In recent years, the opioid epidemic and new hepatitis C virus (HCV) treatments have changed the landscape of organ procurement and allocation. We studied national trends in solid organ transplantation (2000⁻2016), focusing on graft utilization from HCV seropositive deceased donors in the pre-2014 (2000⁻2013) versus current (2014⁻2016) eras with a retrospective analysis of the United Network for Organ Sharing database. During the study period, HCV seropositive donors increased from 181 to 661 donors/year...
July 10, 2018: Diseases (Basel)
Ashton A Shaffer, Christine M Durand
Purpose of Review: The prevalence of end-stage organ disease is increasing among HIV-infected (HIV+) individuals. Individuals with well-controlled HIV on antiretroviral therapy (ART), without active opportunistic infections or cancer, and with specified minimum CD4 cell counts are appropriate transplant candidates. Infectious disease clinicians can improve access to transplantation for these patients and optimize management pre- and post-transplant. Recent Findings: Clinical trials and registry-based studies demonstrate excellent outcomes for select HIV+ kidney and liver transplant recipients with similar patient and graft survival as HIV-uninfected patients...
March 2018: Current Treatment Options in Infectious Diseases
Ahmed Abdelfattah Denewar, Mohamed Hamed Abbas, Hussein Attiya Sheashaa, Ibrahim Abdelaal, Khaled El-Dahshan, Yasser Elsayed Matter, Ayman Fathi Refaie
OBJECTIVES: Liver disease is an important cause of morbidity and mortality among recipients of transplanted organs. In addition to the liver, hepatitis C virus infection has a significant prevalence among recipients of kidney transplant and is related to worse graft and recipient survival as the kidney is an important component of the hepatitis C virus clinical syndrome. MATERIALS AND METHODS: This retrospective single center study included 336 patients with end-stage renal disease who received a kidney transplant at the Mansoura Urology and Nephrology Center from January 1992 to December 1995...
June 28, 2018: Experimental and Clinical Transplantation
E Veitsman, E Pras, O Pappo, A Arish, R Eshkenazi, C Feray, J Calderaro, D Azoulay, Z Ben Ari
Hereditary hemochromatosis (HH) is a genetic disease associated with progressive iron overload, eventually leading in some cases to damage of parenchymal organs, such as the liver, pancreas, and heart. Although the gene had been identified (HFE), HH pathogenesis remains to be fully elucidated. We report here, for the first time, a case of inadvertent transplantation of a liver from a donor with C282Y/H63D compound heterozygosity into a nonhemochromatotic 19-year-old Caucasian male recipient with primary sclerosing cholangitis...
2018: Case Reports in Hepatology
M Berenguer, K Agarwal, P Burra, M Manns, D Samuel
Antiviral therapy to eradicate hepatitis C virus (HCV) infection improves outcomes in patients undergoing liver transplantation (LT) for advanced chronic HCV with or without hepatocellular carcinoma. Traditionally, antiviral therapy focused on the use of interferon (IFN)-based regimens, with antiviral treatment initiated in the post-transplant period once recurrent HCV disease with fibrosis in the allograft was identified. The use of IFN-based therapy was limited in pre-transplant patients with advanced liver disease...
June 23, 2018: American Journal of Transplantation
James C Meek, Jonathan S McDougal, Daniel Borja-Cacho, Mary E Meek
Hepatic artery thrombosis (HAT) is a major cause of morbidity and mortality after orthotopic liver transplantation, occurring in 5% of cases (Piardi et al, 2016). HAT is the second main cause of graft loss after primary nonfunction, the leading cause of graft failure in the immediate postoperative period (<1 month), and is associated with a mortality rate of up to 60% without intervention (Piardi et al, 2016; Pareja et al., 2010; Crossin et al., 2003). Although retransplantation is the preferred therapy, the limited availability of donor organs can necessitate urgent, alternative treatment...
April 2018: Radiology Case Reports
Claire Aguilar, Shahid Husain, Olivier Lortholary
Background: Undergoing solid organ transplantation (SOT) exposes the recipient to various infectious risks, including possible transmission of pathogen by the transplanted organ, post-surgical infections, reactivation of latent pathogens, or novel infections. Recent advances: In the last few years, the emergence of Zika virus has raised concerns in the transplant community. Few cases have been described in SOT patients, and these were associated mainly with moderate disease and favorable outcome; the notable exception is a recent case of fatal meningo-encephalopathy in a heart transplant recipient...
2018: F1000Research
Yasbanoo Moayedi, Aliya F Gulamhusein, Heather J Ross, Jeffrey J Teuteberg, Kiran K Khush
The current mismatch between supply and demand of organs has prompted transplant clinicians to consider innovative solutions to broaden the donor pool. Advancements of direct-acting antiviral agent (DAA) therapy for hepatitis C virus (HCV) have allowed entertaining the use of viremic donor organs in nonviremic recipients. In this report, we describe the evolution of HCV treatment, ethics and informed consent, cost-effectiveness of HCV medications in treating acute HCV post-transplantation, and the Stanford experience with two HCV-viremic donor heart transplantations...
July 2018: Clinical Transplantation
A Oruc, A Ersoy
OBJECTIVE: Besides severe organ shortage, hepatitis C virus (HCV) infection is an important obstacle for kidney transplantation because of long waiting times on deceased kidney donor waiting lists. We aimed to evaluate calling number of candidates according to HCV serology. METHOD: A total of 404 adults on the deceased donor waiting list invited for cadaveric transplantation was evaluated. Demographic data, waiting time, calling number for transplantation, and viral serology were obtained during the 6-year period...
April 18, 2018: Transplantation Proceedings
R Adekunle, S Jonchhe, B Ravichandran, E Wilson, J Husson
A shortage in organs for transplantation has led to the increased use of hepatitis C (HCV) infected donor organs for solid organ transplant recipients infected with HCV. However, the donor HCV genotype is not routinely checked or known prior to transplant. Here, we report 4 cases of genotype conversion after transplantation in patients receiving HCV infected donor organs. This change in genotype may potentially impact HCV progression as well as treatment choice for these patients.
May 24, 2018: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Lucy Somerville, Karen Doucette
PURPOSE OF REVIEW: To highlight the changing landscape of hepatitis C virus (HCV) infection in the context of organ transplantation. This focuses on areas of controversy and future potential in the era of highly effective direct-acting antiviral (DAA) agents. RECENT FINDINGS: Since the advent of safe and highly effective DAA therapy, HCV infection is now curable in virtually all cases, including organ transplant recipients. Excellent drug tolerability and safety combined with high cure rates across all organ groups means that HCV is no longer a barrier to transplantation or its outcomes...
May 22, 2018: Current Infectious Disease Reports
Thaddaeus May, Kevin C Klatt, Jacob Smith, Eumenia Castro, Mark Manary, Marie A Caudill, Farook Jahoor, Marta L Fiorotto
Hepatic steatosis is a hallmark feature of kwashiorkor malnutrition. However, the pathogenesis of hepatic steatosis in kwashiorkor is uncertain. Our objective was to develop a mouse model of childhood undernutrition in order to test the hypothesis that feeding a maize vegetable diet (MVD), like that consumed by children at risk for kwashiorkor, will cause hepatic steatosis which is prevented by supplementation with choline. A MVD was developed with locally sourced organic ingredients, and fed to weanling mice ( n = 9) for 6 or 13 days...
May 22, 2018: Nutrients
Robert L Gottlieb, Shelley A Hall
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...
2018: Current Transplantation Reports
P-J Park, Y-D Yu, Y-I Yoon, S-R Kim, D-S Kim
BACKGROUND: Liver transplantation (LT) is an established therapeutic modality for patients with end-stage liver disease. The use of marginal donors has become more common worldwide due to the sharp increase in recipients, with a consequent shortage of suitable organs. We analyzed our single-center experience over the last 8 years in LT to evaluate the outcomes of using so-called "marginal donors." METHODS: We retrospectively analyzed the database of all LTs performed at our institution from 2009 to 2017...
May 2018: Transplantation Proceedings
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