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Updated: Aug 22, 2025
Murine Heterotopic Heart Transplant Technique
Published on: July 8, 2014
Outcomes of Over 1000 Heart Transplants Using Hepatitis C-Positive Donors in the Modern Era
Jennie H Kwon1, Morgan A Hill1, Raj Patel1
1Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina.
Insights
Hepatitis C virus (HCV)-positive donors are increasingly used for heart transplants (HT). This study found that recipients of HCV-positive hearts have similar survival rates to those receiving HCV-negative hearts, even with NAT-positive donors.
Area of Science:
- Cardiology
- Infectious Diseases
- Transplantation Medicine
Background:
- Advances in hepatitis C virus (HCV) treatment and the opioid epidemic have increased the availability of HCV-positive donors for heart transplantation (HT).
- This analysis examines outcomes of over 1000 HCV-positive HTs in the United States during the modern era.
Purpose of the Study:
- To evaluate the outcomes of heart transplantation using organs from HCV-positive donors.
- To compare survival rates between recipients of HCV-positive and HCV-negative donor hearts.
- To assess the impact of nucleic acid amplification test (NAT) positivity in HCV-positive donors on transplant outcomes.
Main Methods:
- Utilized the United Network of Organ Sharing registry to identify heart transplants performed between 2015 and 2021.
- Grouped recipients by donor HCV status (positive/negative) and NAT positivity.
- Employed Cox regression for risk adjustment and Kaplan-Meier analysis for survival estimation, focusing on 1- and 3-year mortality.
Main Results:
- The frequency of HCV-positive HT increased significantly from 0.12% in 2015 to 12.9% in 2021.
- Of 16,648 HTs, 1170 (7.0%) used organs from HCV-positive donors; recipients were more likely to be older and White.
- Risk-adjusted analysis showed no significant difference in 1- or 3-year mortality between recipients of HCV-positive and HCV-negative organs. NAT positivity did not impact 1-year mortality.
Conclusions:
- The use of HCV-positive donor hearts for transplantation has increased dramatically.
- Heart transplantation using HCV-positive organs, including NAT-positive donors, demonstrates acceptable outcomes.
- Recipients of HCV-positive hearts exhibit similar early to midterm survival rates compared to recipients of HCV-negative organs.
Background:
Advances in hepatitis C virus (HCV) treatment and the ongoing opioid epidemic have made HCV-positive donors increasingly available for heart transplantation (HT). This analysis reports outcomes of over 1000 HCV-positive HTs in the United States in the modern era.
Methods:
The United Network of Organ Sharing registry was used to identify HTs between 2015 and 2021. Recipients were grouped by donor HCV status and by nucleic acid amplification test (NAT) positivity. The primary outcome was 1-year mortality, and secondary outcomes included 3-year mortality. A subanalysis compared HCV-positive HT outcomes between NAT-positive and NAT-negative donors. Risk adjustment was performed using Cox regression. Kaplan-Meier analysis was used to estimate survival.
Results:
The frequency of HCV-positive HT increased from 0.12% of HTs in 2015 to 12.9% in 2021 (P < .001). Of 16,648 HTs, 1170 (7.0%) used an organ from an HCV-positive donor. Recipients of HCV-positive organs were more likely to be HCV seropositive, older, and White. Unadjusted 1- and 3-year survival rates were not significantly different between recipients of HCV-negative and HCV-positive organs. After risk adjustment HCV-positive donor status was not associated with an elevated risk for 1-year (hazard ratio, 0.92; 95% CI, 0.71-1.19; P = .518) or 3-year mortality. Among HCV-positive HTs 772 (61.7%) were NAT positive. After risk adjustment NAT positivity did not impact 1-year mortality.
Conclusions:
The proportion of HCV-positive HTs has increased over 100-fold in recent years. This analysis of the US experience demonstrates that recipients of HCV-positive hearts, including those that are NAT positive, have acceptable outcomes with similar early to midterm survival as recipients of HCV-negative organs.
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