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Center-level Utilization of Hepatitis C Virus-positive Donors for Orthotopic Heart Transplantation
Lauren V Huckaby1, Laura M Seese2, Robert Handzel3
1Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Insights
The use of hepatitis C virus-positive (HCV+) donors for heart transplants (OHT) is rapidly increasing. However, many transplant centers still do not utilize these donors, limiting access to OHT for patients with heart failure.
Area of Science:
- Cardiology
- Transplantation Surgery
- Infectious Diseases
Background:
- The donor pool for orthotopic heart transplantation (OHT) has been expanded by utilizing hepatitis C virus-positive (HCV+) donors.
- This study investigates center-level trends and the utilization patterns of HCV+ donors in OHT.
Purpose of the Study:
- To evaluate the trends and utilization of HCV+ donors for OHT across different transplant centers.
- To compare characteristics of centers that utilize HCV+ donors for HCV- recipients versus those that do not.
Main Methods:
- Data from the Scientific Registry of Transplant Recipients (SRTR) for adult OHT recipients (2016-2019) were analyzed.
- Centers performing fewer than 10 OHTs were excluded. Donor utilization rates and center characteristics were compared.
Main Results:
- The number of OHTs using HCV+ donors increased significantly from 0.60% in 2016 to 11.45% in 2019.
- Center utilization of HCV+ donors rose from 6.67% in 2016 to 52.89% in 2019.
- Centers utilizing HCV+ donors had higher overall donor utilization rates and higher annual OHT volumes.
Conclusions:
- Despite the rapid expansion of HCV+ donor use in OHT, nearly half of US transplant centers are not utilizing them.
- Wider education and standardized protocols for HCV+ donor utilization could increase OHT access for patients with end-stage heart failure.
Background:
The use of hepatitis C virus-positive (HCV+) donors has expanded the donor pool for orthotopic heart transplantation (OHT). This study evaluated center-level trends and utilization of HCV+ donors for OHT.
Methods:
Data were extracted from the Scientific Registry of Transplant Recipients on adults (≥18 y) undergoing OHT between January 1, 2016 and December 31, 2019. Centers performing <10 OHTs during the study period were excluded. Donor utilization rates were evaluated at the center level. Center-level characteristics were compared between centers performing HCV+ donor hepatitis C virus-negative (HCV-) recipient OHTs and those not utilizing HCV+ donors for HCV- recipients.
Results:
A total of 10 134 patients underwent OHT, including 613 (6.05%) HCV+ donors transplanted into HCV- recipients. The number of HCV+ OHTs increased from 15 of 2512 (0.60%) in 2016 to 285 of 2490 (11.45%) in 2019 (P < 0.001). In 2016, among 105 centers performing OHTs, 7 (6.67%) utilized HCV+ donors compared to 2019 during which 55 (52.89%) of 104 centers utilized HCV+ donors (P < 0.001). In total, 57 of 107 (53.27%) centers utilized HCV+ donors during the study period. Centers utilizing HCV+ donors had higher overall donor utilization rates (7376/24 378 [30.26%] versus 3463/15 335 [22.58%], P < 0.001) and were higher volume as compared to nonutilizing centers (mean annual OHT volume 30.72 ± 1.21 versus 16.2 ± 1.40, P < 0.001).
Conclusions:
Although the use of HCV+ donors for OHT is rapidly expanding in the United States, almost half of transplant centers remain nonutilizers. Broader education and implementation of HCV+ donor protocols may be important in expanding OHT to more patients with end-stage heart failure.
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