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Bypassing the bottleneck: intentional hepatitis C transmission with organ transplant
Christine M. Durand, Michael A. Chattergoon
Christine M. Durand, Michael A. Chattergoon
Published June 24, 2019
Citation Information: J Clin Invest. 2019;129(8):3038-3040. https://doi.org/10.1172/JCI129982.
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Commentary

Bypassing the bottleneck: intentional hepatitis C transmission with organ transplant

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Abstract

Solid organ transplantation from hepatitis C virus–positive (HCV-positive) deceased donors into HCV-negative recipients is a recent approach aimed to expand the donor organ pool in the setting of severe shortage. Good short-term outcomes have been reported with this approach in combination with direct-acting antivirals. In this issue of the JCI, Zahid and colleagues have characterized early viral kinetics and the genetic landscape of donor-to-recipient HCV transmission using single-genome sequencing. In seven HCV-negative recipients of four HCV-positive donor organs, productive infection with a highly diverse viral population was seen by day three after transplant. The degree of genetic diversity seen in recipients of HCV-positive organs was unlike the narrow genetic bottleneck typically observed with acute HCV acquisition from intravenous drug use or sexual activity. All recipients achieved HCV cure with treatment. The consequences of acute infection with a genetically diverse HCV population are unknown; however, early clinical experience with this transplantation strategy is promising.

Authors

Christine M. Durand, Michael A. Chattergoon

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Figure 1

Transmission of HCV from donor organs does not encounter the genetic bottleneck observed in other routes of HCV transmission.

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Transmission of HCV from donor organs does not encounter the genetic bot...
(A) Sexual and parenteral transmission of HCV, such as occurs with i.v. drug use, results in a stringent bottleneck in which a single strain expands and dominates at the acute phase of infection. (B) In this issue of the JCI, Zahid and colleagues demonstrate that this bottleneck is lacking in HCV infection acquired via receipt of organs from HCV-positive donors. Moreover, the viral diversity observed in organ recipients during acute infection mimics the viral diversity of the donor.
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