The Impact of HCV Viremia in Heart Transplant Recipients from Donors with HCV Infection on Acute and Humoral Cellular Rejection

Purpose Transmission of HCV infection can induce an inflammatory response, but its impact on accentuating the immune response on the allograft is unknown. Methods From January to October 2018, 25 hepatitis C seronegative patients were transplanted with 12 patients from HCV viremic donors (NAT+). Incidence of acute cellular and humoral rejection were compared between the 2 groups. All patients received standard triple immunotherapy and those who developed HCV were treated with glecaprevir/pibrentasvir (Mavyret) for 8 weeks. Results For all patients, the retrospective flow cytometry crossmatch was negative for both T and B cells and no DSA were detected. Hep C viremia developed at 1-week post-transplant in all recipients of HCV donors. At a mean follow up of 147 ± 88 days in the HCV group: there were 4 grade 2R/ 3A rejection (33%) and 7 grade 1R/2 (58%). In the nonviremic group: there were 2 patients who had grade 2R/3A (20%) and 4 had grade 1R/2 (30%). No grade 3R or humoral rejection was identified in either group. Only grade 1R/2 rejection was statistically significant between the 2 groups. There was no difference in the type of inflammatory cells in the endomyocardial biopsy between the two groups. Conclusion Early biopsy of heart transplantation from donors with active hepatitis C is not associated with high grade cellular or any humoral rejection. The 1R/2A rejections seems to be more frequent in the HCV group and did not correlate with the level of viremia. Longer follow up and the impact on chronic allograft vasculopathy would need to be assessed in the future.