Zepatier For Treatment Of Hepatitis C-Negative Patients Who Receive Heart Transplants From Hepatitis C-Positive Donors (HCV)

Inclusion Criteria: * New York Heart Association (NYHA) Class III or IV CHF refractory to maximal medical therapy (ACE inhibitor, B-blocker, digoxin and diuretics, resynchronization therapy or Implantable Cardioverter Defibrillator when applicable) and/or conventional surgery. * Inoperable coronary artery disease with intractable anginal symptoms * Malignant ventricular arrhythmias unresponsive to medical or surgical therapy * 18-65 years of age * Obtained agreement for participation from the transplant cardiology team * No evident contraindication to liver transplantation other than the underlying cardiac disorder * Able to travel to the University of Pennsylvania for routine post-transplant visits and study visits for a minimum of 6 months after transplantation * No active illicit substance abuse * Women must agree to use birth control in accordance with Mycophenolate Risk Evaluation and Mitigation Strategy (REMS) following transplant due to the increased risk of birth defects and/or miscarriage * Both men and women must agree to use at least one barrier method of birth control or remain abstinent following transplant due to risk of HCV transmission * Inclusion criteria for treatment (not for entry as study patient) will include any detectable HCV RNA by week 4 post-heart transplantation * Able to provide informed consent Exclusion Criteria: * Hepatocellular carcinoma * HIV positive * HCV antibody positive and/or RNA positive * Hepatitis B surface antigen, core antibody, and/or DNA positive * Any other chronic liver disease (excluding non-alcoholic fatty liver disease (NAFLD) with abnormal liver enzymes * Persistently elevated liver transaminases * Congenital heart disease * Fibrosis by liver biopsy or total bilirubin \> 2.5 with associated evidence of synthetic dysfunction. * Pregnant or nursing (lactating) women * Known allergy or intolerance to tacrolimus that would require post-transplant administration of cyclosporine, rather than tacrolimus given the drug-drug interaction between cyclosporine and ZEPATIER * Waitlisted for a multi-organ transplant * Evidence of end organ damage due to diabetes (e.g. retinopathy, nephropathy, ulcerations) and /or brittle diabetes mellitus (e.g. history of diabetic ketoacidosis) and/or uncontrolled diabetes as evidence by a HgbA1C of 7.5-8.5. * Chronic bronchitis, chronic obstructive pulmonary disease, inability to stop smoking. * Hematologic: Significant coagulation abnormalities, bleeding diatheses. * Psychosocial: Profound neurocognitive impairment with absence of social support. * Active mental illness or psychosocial instability * Inadequate insurance or financial support for post-transplant care. * Evidence of drug, tobacco or alcohol abuse within the past six months and completion of recommended therapy/services or meets satisfied parameters as indicated by social work staff and/or consult team. * History of chronic non-compliance. * Amyloidosis (restricted to cardiac only, without evidence of extra cardiac involvement) * BMI ≥38 * Active peptic ulcer disease. * Severe malnutrition. * Major chronic disabling illness (e.g. lupus, severe arthritis, neurologic diseases, previous stroke with profound residual). * Pulmonary infarction within the past 6 weeks * Severe pulmonary hypertension as evidenced by a fixed pulmonary vascular resistance of greater than 4 Wood units on appropriate medical therapy. * Patient refusal to receive blood products or transfusions during heart transplant surgery. * Severe chronic obstructive pulmonary disease * Current clinical sepsis. * Symptomatic or severe vascular disease. * Chronic Kidney Disease Stage IV, Glomerular Filtration Rate \< 30 * History of Mantle radiation. * Asymptomatic renal cell carcinoma \<1 year from curative treatment. * Symptomatic renal cell carcinoma \<5 years from curative treatment. * Prostate cancer \<2 years from curative treatment. * Uterine or cervical cancer \<2 years from curative treatment. * Any other cancer other than the above including malignant melanoma, \< 5 years from treatment apart from other skin malignancies. Donor Organ Selection Criteria: General criteria (although there can be exceptions on a case-by-case basis) * Detectable HCV RNA * Genotype 1 or 4 HCV * Age \<=55 years * No history of coronary artery disease * No congenital heart disease except a repaired atrial septal defect (ASD) provided the patient has normal right ventricular function * No history of arrhythmia (atrial fibrilation, atrial flutter or VT) except during resuscitation from fatal event. * No evidence of cirrhosis Echocardiographic criteria: * Left ventricular ejection fraction (LVEF) \>=50% * Normal right ventricular function * No left ventricular hypertrophy (LVH) - septal wall thickness \<1 cm * No left ventricular hypertrophy (LVH)- posterior wall thickness \<1 cm * No significant valvular heart disease - more than mild tricuspid regurgitation, more than mild mitral regurgitation, more than trace aortic regurgitation. No mitral or aortic stenosis. * No congenital heart disease - transposition of the great vessels, ventricular septal defect (VSD), ASD, and/or single ventricle (Fontan) Right heart catheterization criteria: * Right atrial pressure \<=10mmHg * Pulmonary capillary wedge pressure \<=18mmHg * CI \>=2.1 l/min/m2 * Pulmonary hypertension is allowed if the patient has normal right ventricular function and a normal tricuspid valve