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Trends in the use of hepatitis C viremic donor hearts
Selena S Li1, Asishana Osho2, Philicia Moonsamy2
1Department of Surgery, Massachusetts General Hospital, Boston, Mass.
Insights
Hepatitis C virus (HCV) viremic donor hearts are increasingly used for transplantation, showing comparable short-term survival rates. However, regional disparities and long-term outcomes require further investigation.
Area of Science:
- Organ transplantation
- Infectious disease epidemiology
- Hepatitis C virus (HCV) research
Background:
- The organ donor shortage necessitates innovative strategies to expand organ availability.
- Hepatitis C virus (HCV) viremic donors represent a potential source of organs for transplantation.
- Understanding the trends and outcomes of using HCV viremic donor hearts is crucial.
Purpose of the Study:
- To examine the utilization trends of hearts from HCV viremic donors for transplantation.
- To assess the short-term outcomes of heart transplantation using HCV viremic donor organs.
- To identify geographical and institutional variations in the use of these organs.
Main Methods:
- Utilized the United Network for Organ Sharing (UNOS) registry for adult heart transplantations between 2015 and 2019.
- Excluded multiorgan transplants, incomplete data, and loss to follow-up.
- Defined HCV status using nucleic acid testing (NAT).
Main Results:
- The use of HCV NAT+ donor hearts increased significantly from 2015 to 2018.
- Transplantations from HCV NAT+ donors showed longer travel distances and ischemic times compared to NAT- donors.
- Short-term survival, acute rejection, and 30-day mortality were comparable between recipients of NAT+ and NAT- donor hearts.
- Within one year, 38 recipients seroconverted and 14 became viremic, with high survival rates in both subgroups.
Conclusions:
- The utilization of HCV viremic donor hearts for transplantation is rising but shows significant regional and center-specific variability.
- Short-term outcomes for heart transplantation using HCV viremic donor organs are comparable to those from non-viremic donors.
- Long-term outcomes and the full impact of seroconversion require continued monitoring and research.
Objective:
To examine trends in utilization of hearts from hepatitis C virus (HCV) viremic donors for transplantation, a strategy to expand organ availability.
Methods:
The United Network for Organ Sharing (UNOS) registry was queried for adult patients undergoing heart transplantation between 2015 and 2019. We excluded multiorgan transplants, incomplete data, and loss to follow-up. Nucleic acid testing (NAT) defined HCV status.
Results:
Between 2015 and 2019, a total of 11,393 adults underwent heart transplantation: 326 from HCV NAT+ donors and 11,067 from NAT- donors. The use of NAT+ hearts increased from 1 in 2015 to 137 in 2018 against a static number of NAT- organs. The use of NAT+ hearts varied significantly across regions and individual centers. More than 75% of NAT+ hearts were transplanted in the Northeast region, leading to further travel (mean, 299 miles vs 173 miles for NAT- transplantations; P < .001), with longer ischemic times (mean: 3.52 hours vs 3.10 hours; P < .001). More than one-half of NAT+ transplantations were performed by 5 individual centers, and a single institution accounted for >20% of all transplantations from viremic donors. Survival in the 2 groups did not differ by Kaplan-Meier analysis (P = .240), and multivariable regression showed no differences in acute rejection (P = .455) or 30-day mortality (P = .490). Of the 326 recipients of NAT+ hearts, 38 seroconverted and 14 became viremic within 1 year. Survival was 100% in the viremic patients and 97.4% in seroconverted patients at 1 year.
Conclusions:
Heart transplantation from HCV viremic donors continues to increase but varies significantly across UNOS regions and individual centers. Short-term outcomes are comparable, but effects of seroconversion and long-term outcomes remain unclear.
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