Early Outcomes of Multivisceral Transplant Using Hepatitis C-Positive Donors

Area of Science:

• Transplantation immunology
• Organ donor management
• Cardiovascular and renal medicine

Background:

• Direct-acting antiviral therapies have enabled the use of hepatitis C-positive organs to expand the donor pool.
• Combined heart/kidney transplantation is beneficial for patients with heart failure and renal insufficiency.
• The study initiated the use of hepatitis C-positive donors for heart/kidney transplants in 2017.

Purpose of the Study:

• To evaluate the outcomes of heart/kidney transplantation using hepatitis C-positive (HCV+) versus hepatitis C-negative (HCV-) donor organs.
• To compare patient survival, allograft function, and waitlist times between the two donor groups.
• To assess the viability of HCV+ organs as a strategy to increase organ availability.

Main Methods:

• A retrospective analysis of heart/kidney transplant recipients from 2012-2019.
• Patients were stratified into cohorts based on donor hepatitis C antibody status (HCV+ vs. HCV-).
• Outcomes analyzed included survival rates, postoperative cardiac and renal function, and median waitlist duration.

Main Results:

• Twelve recipients received HCV+ organs, and 27 received HCV- organs, with comparable donor and recipient characteristics.
• Recipients of HCV+ organs experienced a shorter median waitlist time.
• Both groups demonstrated similar early cardiac function, renal graft function, and 30-day/1-year survival rates, despite transiently higher creatinine levels in the HCV+ group at 3 months.

Conclusions:

• Hepatitis C-positive donors represent a valuable resource for expanding the organ supply for heart/kidney transplantation.
• The benefits of reduced waitlist times and comparable survival outweigh the potential for early renal dysfunction.
• Utilizing HCV+ organs is a viable strategy to improve access to life-saving transplants for eligible patients.