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Local and regional variability in utilization and allocation of hepatitis C virus-infected hearts for transplantation
Katya Prakash1, Charles Wainana2, Jeffrey Trageser2
1Division of Infectious Diseases, University of California, San Diego, California, USA.
Insights
Hepatitis C virus-infected (HCV+) hearts are increasingly used in heart transplants. Despite national progress, regional disparities and variable allocation by organ procurement organizations persist, impacting organ availability.
Area of Science:
- Cardiology
- Transplantation Immunology
- Infectious Diseases
Background:
- Direct-acting antiviral agents have increased the use of hepatitis C virus-infected (HCV+) hearts for transplantation.
- Understanding regional and local variations in the utilization and allocation of HCV+ donor hearts is crucial.
Purpose of the Study:
- To compare national and regional utilization rates of HCV-uninfected (HCV-) versus HCV+ nonviremic (HCV-NV) and viremic (HCV-V) hearts.
- To evaluate organ procurement organization (OPO)-level allocation rates for HCV+ hearts.
- To identify disparities in HCV+ heart utilization and allocation across the United States.
Main Methods:
- Analysis of United Network for Organ Sharing (UNOS) de-identified data from January 1, 2016, to September 30, 2019.
- Comparison of utilization rates (hearts transplanted/donors recovered) for HCV-, HCV-NV, and HCV-V hearts nationally and by UNOS region.
- Evaluation of allocation rates (hearts successfully allocated/donors recovered) by OPO.
Main Results:
- National utilization rates for HCV-NV and HCV-V hearts matched HCV- hearts in 2019.
- Low utilization rates for HCV-NV hearts were observed in UNOS regions 3 and 4.
- Low utilization rates for HCV-V hearts were noted in UNOS regions 3, 4, and 8.
- Significant variability in HCV+ heart allocation was found at the OPO level, even within the same UNOS region.
Conclusions:
- National efforts have improved HCV+ heart utilization for transplantation.
- Further improvements in HCV+ heart allocation at the OPO level could significantly alleviate organ shortages.
- Addressing regional and OPO-level disparities is key to optimizing the use of HCV+ donor hearts.
Abstract:
With the advent of direct-acting antiviral agents, there has been a rapid rise in hepatitis C virus-infected (HCV+) heart transplantation. We aimed to understand local and regional differences in utilization and allocation of HCV+ hearts. Using United Network for Organ Sharing (UNOS) de-identified data from January 1, 2016 to September 30, 2019 we compared trends in the utilization rates (hearts transplanted/donors recovered) of HCV-uninfected (HCV-) to those of HCV+ nonviremic (HCV-NV) and viremic (HCV-V) hearts nationally and by UNOS region. We also evaluated allocation rates (hearts successfully allocated/donors recovered) by organ procurement organization (OPO). We found that (1) in 2019, national utilization rates for HCV-NV and HCV-V hearts were the same as HCV- hearts (27.6% for HCV-NV, 30.9 for HCV-V, and 31.7% for HCV-, P = .277); (2) utilization rates of HCV-NV hearts were low in regions 3 and 4 and of HCV-V hearts in regions 3, 4, and 8 even in the contemporary period since 2018; and (3) there was marked variability in allocation of HCV+ hearts at the OPO level even within the same UNOS region. We conclude that despite national strides in the utilization of HCV+ hearts for transplantation, more aggressive allocation of HCV+ hearts at the OPO level may still significantly affect the organ shortage.
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