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. 2022 Nov 3:12:269-279.
doi: 10.1016/j.xjon.2022.10.007. eCollection 2022 Dec.

Trends and three-year outcomes of hepatitis C virus-viremic donor heart transplant for hepatitis C virus-seronegative recipients

Jessica M Ruck  1 , Alice L Zhou  1 , Laura B Zeiser  1 , Diane Alejo  1 , Christine M Durand  2 , Allan B Massie  3 , Dorry L Segev  3   4 , Errol L Bush  1 , Ahmet Kilic  1
Affiliations

Trends and three-year outcomes of hepatitis C virus-viremic donor heart transplant for hepatitis C virus-seronegative recipients

Jessica M Ruck et al. JTCVS Open. .

Abstract

Objective: Heart transplants (HTs) from hepatitis C virus (HCV)-viremic donors to HCV-seronegative recipients (HCV D+/R-) have good 6-month outcomes, but practice uptake and long-term outcomes overall and among candidates on mechanical circulatory support (MCS) have yet to be established.

Methods: Using the Scientific Registry of Transplant Recipients, we identified US adult HCV-seronegative HT recipients (R-) from 2015 to 2021. We classified donors as HCV-seronegative (D-) or HCV-viremic (D+). We used multivariable regression to compare post-HT extracorporeal membranous oxygenation, dialysis, pacemaker, acute rejection, and risk of post-HT mortality between HCV D+/R- and HCV D-/R-. Models were adjusted for donor, recipient, and transplant characteristics and center HT volume. We performed subgroup analyses of recipients bridged with MCS.

Results: From 2015 to 2021, the number of HCV D+/R- HT increased from 1 to 181 and the number of centers performing HCV D+/R- HT increased from 1 to 60. Compared with HCV D-/R- recipients, HCV D+/R- versus D-/R- recipients overall and among patients bridged with MCS had similar odds of post-HT extracorporeal membranous oxygenation, dialysis, pacemaker, and acute rejection; and mortality risk at 30 days, 1 year, and 3 years (all P > .05). High center HT volume but not HCV D+/R- volume (<5 vs >5 in any year) was associated with lower mortality for HCV D+/R- HT.

Conclusions: HCV D+/R- and D-/R- HT have similar outcomes at 3 years' posttransplant. These results underscore the opportunity provided by HCV D+/R- HT, including among the growing population bridged with MCS, and the potential benefit of further expanding use of HCV+ allografts.

Keywords: D+, HCV-viremic donor; DAAs, direct-acting antivirals; DCD, donation after circulatory death; D–, HCV-seronegative donor; ECMO, extracorporeal membranous oxygenation; HCV, hepatitis C virus; HT, heart transplant; IABP, intra-aortic balloon pump; IQR, interquartile range; LVAD, left ventricular assist device; MCS, mechanical circulatory support; R–, HCV-seronegative recipient; SRTR, Scientific Registry of Transplant Recipients; aHR, adjusted hazard ratio; aOR, adjusted odds ratio; donor pool; heart transplant; hepatitis C; outcomes.

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Figures

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Graphical abstract
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Mortality among US recipients of HCV-viremic and HCV-seronegative heart transplants.
Figure 1
Figure 1
Number of (A) transplants and (B) transplant centers by donor and recipient HCV status. HCV, Hepatitis C virus; HCV D+/R–, viremic donor to seronegative recipient; HCV D–/R–, seronegative donor to seronegative recipient.
Figure 2
Figure 2
Mortality by time since heart transplant. HCV, Hepatitis C virus; HCV D–/R–, seronegative donor to seronegative recipient; HCV D+/R–, viremic donor to seronegative recipient; CI, confidence interval; aHR, adjusted hazard ratio.
Figure 3
Figure 3
Kaplan–Meier survival curves of HCV D–/R– versus HCV D+/R– heart transplants in recipients bridged with (A) LVAD and (B) IABP. LVAD, Left ventricular assist device; HCV, hepatitis C virus; HCV D–/R–, seronegative donor to seronegative recipient; HCV D+/R–, viremic donor to seronegative recipient; IABP, intra-aortic balloon pump; CI, confidence interval.
Figure 4
Figure 4
Heart transplants from donors with and without HCV viremia into recipients without HCV have similar risk of acute rejection and mortality at 3 years' posttransplant. HCV, Hepatitis C virus; HCV D+/R–, viremic donor to seronegative recipient; MCS, mechanical circulatory support; ECMO, extracorporeal membranous oxygenation.
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