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Utilization of hepatitis C virus infected donors in heart transplant recipients with elevated MELD-XI score
Rahim Hirani1, Kenji Okumura2, Ameesh Isath3
1New York Medical College, Valhalla, New York, USA.
Insights
Heart transplants from hepatitis C virus positive (HCV+) donors are safe for recipients with elevated liver disease scores. This study found no increased mortality risk in these patients, supporting expanded organ utilization.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Direct-acting antivirals have increased the use of organs from hepatitis C virus positive (HCV+) donors.
- Outcomes of heart transplantation (HT) using HCV+ donor hearts in recipients with elevated Model for End-Stage Liver Disease excluding international normalized ratio (MELD-XI) scores remain unclear.
Purpose of the Study:
- To evaluate the safety and outcomes of heart transplantation from HCV+ donors in recipients with elevated MELD-XI scores.
- To compare post-transplant survival between recipients of HCV+ donor hearts and HCV-negative donor hearts stratified by MELD-XI score.
Main Methods:
- A retrospective analysis of the United Network of Organ Sharing database (Jan 2016-Dec 2021).
- Comparison of post-transplant outcomes between 792 heart transplant recipients from HCV+ donors and 15,266 recipients from HCV-negative donors.
- Stratification of recipients into low, medium, and high MELD-XI score groups (<10.37, 10.38-13.39, >13.4 respectively) for comparative survival analysis using Kaplan-Meier and Cox hazard models.
Main Results:
- Median MELD-XI scores were similar between the HCV+ and HCV-negative donor groups (12.1 vs. 11.8).
- Donors in the HCV+ group were older, with longer ischemic times and greater travel distances.
- Kaplan-Meier analysis showed comparable 2-year survival rates across all MELD-XI strata (Low: 92.4% vs. 91.1%, Medium: 89.2% vs. 88.2%, High: 84.9% vs. 84.6%).
- Multivariate Cox models indicated no significant association between HCV+ donors and mortality within any MELD-XI subgroup (aHRs ranging from 0.93 to 1.02, all P > .68).
Conclusions:
- Utilization of HCV+ donor hearts is not associated with increased adverse outcomes in heart transplant recipients with elevated MELD-XI scores.
- These findings support the expanded use of HCV+ donor organs, even in recipients with significant underlying liver disease, to address organ shortages.
Background:
The advent of direct-acting antivirals has helped to increase the safe utilization of organs from hepatitis C virus positive (HCV+) donors. However, the outcomes of heart transplantation (HT) using an HCV+ donor are unclear in recipients with underlying liver disease represented by an elevated model for end-stage liver disease excluding international normalized ratio (MELD-XI).
Methods:
The United Network of Organ Sharing database was queried from Jan 2016 to Dec 2021. Post-transplant outcomes stratified by recipient MELD-XI score (low <10.37, medium, 10.38-13.39, and high >13.4) was compared between patients with HT from HCV+ (N = 792) and patients with HT from HCV-negative donors (N = 15,266).
Results:
The median MELD-XI score was comparable (HCV+, 12.1, vs. HCV-negative, 11.8, p = .37). In the HCV+ group, donors were older (33 vs. 31 years, p < .001). Ischemic time of donor hearts (3.48 vs. 3.28 h, p < .001) and travel distance (250 vs. 157 miles, p < .001) were longer in HCV+ group. In the Kaplan Meier analysis with a median follow-up of 750 days, survival was comparable between the two groups (2-year survival, MELD-XI Low: HCV+, 92.4 ± 3.6% vs. HCV-negative, 91.1 ±.8%, p = .83, Medium: HCV+ 89.2 ± 4.3% vs. HCV-negative, 88.2 ± 1.0%, p = .68, and High: HCV+, 84.9 ± 4.5% vs. HCV-negative, 84.6 ± 1.1%, p = .75) In multivariate Cox hazard models, HCV donors were not associated with mortality in each MELD-XI subgroup (Low: adjusted hazard ratio (aHR), 1.02, p = .94; Medium: aHR, .95, p = .81; and High: aHR, .93, p = .68).
Conclusion:
Utilization of HCV+ hearts was not associated with an increased risk of adverse outcomes in recipients with an elevated MELD- XI score.
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