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Mid-term Waitlist and Posttransplant Outcomes With Hepatitis C-positive Donor Hearts
Yeahwa Hong1,2, Caitlin D Couper3, Nidhi Iyanna2
1Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Insights
Using hepatitis C virus-positive (HCV+) donors for heart transplants is increasing. These transplants improve waitlist outcomes and show comparable survival rates post-transplant.
Area of Science:
- Cardiology
- Transplantation Medicine
- Infectious Diseases
Background:
- Hepatitis C virus (HCV) infection poses challenges in organ transplantation.
- The use of HCV-positive (HCV+) donors in heart transplantation is a growing clinical trend.
- Assessing the impact of HCV+ donors on patient outcomes is crucial for optimizing heart transplant programs.
Purpose of the Study:
- To evaluate the clinical trends of using hepatitis C virus-positive (HCV+) donors in heart transplantation.
- To determine the impact of HCV+ donors on waitlist outcomes, including transplantation rates and mortality.
- To assess posttransplant survival outcomes for recipients of hearts from HCV+ donors compared to HCV-negative donors.
Main Methods:
- Analysis of the United Network for Organ Sharing registry (2015-2022) for adult heart transplant candidates and recipients.
- Stratification of waitlisted candidates based on willingness to accept HCV+ donor offers.
- Stratification of recipients into cohorts based on donor HCV nucleic acid test (NAT) status (positive vs. negative).
- Utilized propensity score-matching and multivariable Cox regression for risk adjustment.
Main Results:
- The number of centers utilizing HCV NAT+ donors increased significantly, with a corresponding rise in transplants.
- Acceptance of HCV+ donors was linked to a higher likelihood of transplantation and reduced death/delisting on the waitlist.
- Recipients of HCV NAT+ hearts (4.7%) demonstrated comparable 1- and 4-year posttransplant survival rates to those receiving NAT- donor hearts.
- These findings remained consistent after propensity score-matching and multivariable regression analyses.
Conclusions:
- The utilization of hepatitis C virus-positive donors in heart transplantation is on the rise.
- Transplants from HCV+ donors are associated with improved waitlist outcomes.
- Heart transplantation using HCV+ donors yields comparable posttransplant survival rates to those from HCV-negative donors.
Background:
This study evaluates the clinical trends and impact of hepatitis C virus-positive (HCV+) donors on waitlist and posttransplant outcomes after heart transplantation.
Methods:
The United Network for Organ Sharing registry was queried to identify adult waitlisted and transplanted patients from January 1, 2015, to December 31, 2022. In the waitlist analysis, the candidates were stratified into 2 cohorts based on whether they were willing to accept HCV+ donor offers. Waitlist outcomes included 1-y cumulative incidences of transplantation and death/delisting. In the posttransplant analysis, the recipients were stratified into 2 cohorts with and without HCV nucleic acid test (NAT)-positive donors. Outcomes included 1- and 4-y posttransplant survival. Propensity score-matching was performed. Risk adjustment was performed using multivariable Cox regression.
Results:
During the study period, the number of centers using HCV NAT+ donors increased from 1 to 65 centers, along with the number of transplants. In the waitlist analysis, 26 648 waitlisted candidates were analyzed, and 4535 candidates (17%) were approved to accept HCV+ donors. Approval to accept HCV+ donors was associated with a higher likelihood of transplantation and a lower likelihood of death/delisting within 1 y of waitlisting. In the posttransplant analysis, 21 131 recipients were analyzed, and 997 recipients (4.7%) received HCV NAT+ hearts. The 1- and 4-y posttransplant survival were comparable between the recipients of HCV NAT+ and NAT- donors. Furthermore, the similar 1- and 4-y posttransplant survival persisted in the propensity score-matched comparison and multivariable Cox regression analysis.
Conclusions:
Utilization of HCV+ donors is rising. Heart transplants using HCV+ donors are associated with improved waitlist and comparable posttransplant outcomes.
