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Commentary:Heart
transplantationusinghepatitis
C–positivedonors:Whatarewe
waitingfor?
MichaelIbrahim,MD,PhD,aandArmanKilic,MDb
MichaelIbrahim,MD,PhD,andArmanKilic,MD
SincetheTHINKER(TransplantingHepatitisCKidneysCENTRALMESSAGE
intoNegativeKidnEyRecipients)trialestablishedthatHearttransplantsusinghepatitis
solid-organtransplantationfromhepatitisCnucleicacidC–positivedonorsshouldbe
amplificationtest(NAT)þkidneydonorsintohepatitisC–
negativepatientswaspossiblewithoutinfectingrecipients,expandedtomorecentersand
,althoughcontinued
Thiserawasusheredinbytheadventofdirect-actinganti-evaluationofacuterejectionand
viralagentsthatcurethevastmajorityofpatientsinfected
,hepatitisCinfectioncoronaryallograftvasculopathy
rateshavedramaticallyfalleninthepopulationbutarenowisneeded.
isthereforedisproportionatelycommoninorgandonors,
dialysis-
whoincludeadisproportionatenumberofoverdosevictims.
addssomegranularityinshowingthepatternofhepatitis
Lackofavailableorgansremainsthemostpressinglimiting
CNATþ,
factorintransplantation,andexpandingthedonorpoolisone
morethan75%ofthesetransplantsoccurredintheNorth-
ofthemostpracticalwaysofaddressingthisproblem.
eastorEasternregions,andmorethan50%wereperformed
Liandcolleagues2presentananalysisofhepatitisC
%ofhepatitisC–
NATþhearttransplantsintheUnitedNetworkforOrgan
negativerecipientsseroconvertedfollowinghearttransplan-
Sharingdatabasebetween2015and2019,withamedian
tationwithahepatitisCNATþ-term
follow-
inabsoluteorpropensity-matchedsurvivalbetweenthe
therateofcoronaryallograftvasculopathywasslightly
hepatitisCNATþandnon--
greaterintheseroconvertedgroup,theratesofhospitaliza-
ouslyshowed,inasimilarcohortofbothmatchedand
,we
non-matchedpatients,thatsurvivalwasalsoequivalent3;
donothavedataonthedirect-actingantiviraltherapy
wealsodemonstratedthatratesofrejection,stroke,and
,intheoriginal
THINKERtrial,allpatientswerecuredofhepatitisusing
FromtheaDivisionofCardiovascularSurgery,TheUniversityofPennsylvania;andadirectactingantiviraltherapyregimenlasting12to
bDivisionofCardiacSurgery,UniversityofPittsburghMedicalCenter,Pittsburgh,
Pa.
Disclosures:DrKilicreportedMedicalAdvisoryBoard,Medtronic,
þ,acutecellularrejection
TheJournalpolicyrequireseditorsandreviewerstodiscloseconflictsofinterestandappearstooccurmorefrequentlyfollowinghepatitisC
todeclinehandlingorreviewingmanuscriptsforwhichtheymayhaveaconflictofþ
,althoughagaindetailsare
ReceivedforpublicationSept14,2020;revisionsreceivedSept14,2020;acceptedlackingastograde,extent,andreversibilityofthese
forpublicationSept15,
Addressforreprints:ArmanKilic,MD,UniversityofPittsburghMedicalCenter,200
LothropSt,SuiteC-700,Pittsburgh,PA15213(E-mail:******@).
JThoracCardiovascSurg2020;-:1-2largesingle-centerandmulticenterstudies.
0022-5223/$-
CopyrightÓþ
forThoracicSurgerytitisCNAThearttransplantationandfurtherdefinessome
/-acting
TheJournalofThoracicandCardiovascularSurgerycVolume-,Number-1
CommentaryIbrahimandKilic
antiviraltherapy,understandingtheimplicationsandmech-References
anismsofmorefrequentcoronaryallograftvasculopathy,,AbtPL,BlumbergEA,VanDeerlinVM,LevineM,ReddyKR,
-infectedkidneysintouninfectedrecipients.
;376:2394-5.
needtobeaddressedashepatitisCNATþ,OshoA,MoonsamyP,D’AlessandroD,LewisG,VillavicencioM,etal.
,thesedatashouldreas-.
September16,2020[Epubaheadofprint].
,HickeyG,MathierM,SultanI,GleasonTG,HornE,
effectiveatexpandingthedonorpool,whichisoururgentadulthearttransplantationusinghepatitisC–.
;9:e014495.
2TheJournalofThoracicandCardiovascularSurgeryc-2020
IbrahimandKilicCommentary
000Commentary:HearttransplantationusinghepatitisC–positivedonors:What
arewewaitingfor?
MichaelIbrahim,MD,PhD,andArmanKilic,MD,Pittsburgh,Pa
HearttransplantsusinghepatitisC–positivedonorsshouldbeexpandedtomorecentersand
patients,althoughcontinuedevaluationofacuterejectionandcoronaryallograftvasculopathyis
needed.
TheJournalofThoracicandCardiovascularSurgerycVolume-,Number-