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Published on: June 5, 2020
Using hepatitis C and B virus-infected donor organs for pediatric heart transplantation
Yasmin Radzi1, Muhammad Farrukh Shezad1, Lara Danziger-Isakov2
1Division of Cardiothoracic Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio.
Insights
Using hepatitis B or C positive donors for pediatric heart transplants shows similar survival rates to negative donors. This approach could expand organ availability and reduce waitlist deaths.
Area of Science:
- Transplantation immunology
- Infectious disease in transplantation
- Pediatric cardiology
Background:
- High-risk donors offer a potential solution to organ shortages in transplantation.
- Utilizing donors positive for hepatitis B virus core antibody (HBcAb+) or hepatitis C virus (HCV+) may increase organ availability.
- Pediatric heart transplantation faces significant challenges with organ scarcity and long waiting lists.
Purpose of the Study:
- To evaluate the safety and efficacy of using HBcAb+ or HCV+ donors for pediatric heart transplantation.
- To compare graft survival rates between recipients of HBcAb+/HCV+ donor hearts and recipients of seronegative donor hearts.
Main Methods:
- Retrospective review of the United Network of Organ Sharing database (June 2008-June 2015).
- Identified 3 HCV+ and 9 HBcAb+ donor hearts for pediatric transplantation.
- Used propensity score matching to compare survival between recipients of seropositive and seronegative donor hearts, controlling for key variables.
Main Results:
- Post-transplant graft survival was similar for recipients of HCV+ donor hearts compared to HCV-negative donors.
- Post-transplant graft survival was similar for recipients of HBcAb+ donor hearts compared to HBcAb-negative donors.
- These findings suggest that HBcAb+ and HCV+ donors can be safely used in pediatric heart transplantation.
Conclusions:
- Despite a small cohort size, the results are encouraging for the use of HBcAb+ and HCV+ donors in pediatric heart transplantation.
- This strategy aligns with trends observed in adult thoracic and pediatric kidney transplantation.
- Further research is needed, but current data indicate these donors are underutilized for pediatric heart recipients.
Objective:
High-risk donors for patients with end-stage cardiac or pulmonary disease awaiting transplantation represent an opportunity for access to more organs and therefore can significantly decrease the waiting list mortality. The objective of this study is to investigate the use of hepatitis B virus core antibody positive or hepatitis C virus seropositive donors for pediatric heart transplantation.
Methods:
Data were reviewed from the United Network of Organ Sharing database (June 2008 to June 2015). A total of 3 hepatitis C seropositive and 9 hepatitis B core antibody positive donor hearts were identified for transplantation. Factors of age, underlying diagnosis, transplant year, extracorporeal membrane oxygenation, inotrope support, hepatitis C virus serostatus, and hepatitis B virus surface antigen status were used for 2 separate propensity score models. Standardized difference was evaluated for these variables before and after match. Survival was compared between the matched cohorts.
Results:
Post-transplant graft survivals for recipients of hepatitis C virus positive donors and hepatitis B virus core antibody positive donors were similar to matched recipients of hepatitis C virus negative and hepatitis B virus core antibody negative donors, respectively.
Conclusions:
The study has a small cohort to derive any significant conclusions, but the results are encouraging and consistent with the current trends among adult thoracic and pediatric kidney transplantation and demonstrates that hepatitis C virus positive and hepatitis B virus core antibody positive donors are not often used for pediatric heart transplantation.
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