Increasing multiorgan heart transplantation with hepatitis C virus donors in the current-era

Area of Science:

• Transplantation immunology
• Organ transplantation
• Hepatology

Background:

• The use of hepatitis C virus (HCV) infected donors for organ transplantation is a growing area of research.
• Contemporary data on the outcomes of multiorgan heart transplantation (HT) utilizing HCV donors are limited.
• Understanding the trends and results of these transplants is crucial for expanding donor pools.

Purpose of the Study:

• To analyze the trends and outcomes of multiorgan heart transplantation using HCV donors in the contemporary era.
• To compare the survival rates and post-transplant complications in recipients of multiorgan heart transplants from HCV-donors versus HCV-naïve donors.
• To evaluate the feasibility and safety of expanding the use of HCV donors for multiorgan HT.

Main Methods:

• Utilized the United Network for Organ Sharing (UNOS) registry to identify 1322 adult multiorgan HTs (heart-kidney, heart-lung, heart-liver) performed between August 2015 and August 2020.
• Categorized 109 transplants performed using HCV donors into HCV-viremic (HCV NAT positive) and HCV antibody positive/nonviremic (HCV Ab+/NAT-) groups.
• Employed unadjusted and adjusted Cox-proportional hazards regression models, including propensity-score matched cohorts, to compare outcomes between HCV-donor and HCV-naïve donor recipients.

Main Results:

• The utilization of HCV donors for multiorgan HT significantly increased from 0% in 2015 to 14% in 2020 (p < 0.001), with regional and center-specific variations.
• One-year survival rates for multiorgan heart-kidney transplant recipients were similar between those receiving organs from HCV-donors (n=90) and HCV-naïve donors (n=896) in both unadjusted and adjusted analyses.
• Post-transplant rates of cardiac allograft vasculopathy and need for chronic dialysis at one year were comparable between the two groups.

Conclusions:

• The use of HCV-donors for multiorgan transplantation, including HCV-viremic and HCV antibody positive nonviremic donors, has markedly increased.
• The encouraging one-year outcomes observed in heart-kidney transplant recipients from HCV-donors suggest this strategy is safe and effective.
• These findings support the further expansion of heart-kidney transplantation utilizing HCV donors to address organ shortages.