Trends and three-year outcomes of hepatitis C virus–viremic donor heart transplant for hepatitis C virus–seronegative recipientsCentral MessagePerspective
Jessica M. Ruck, MD,
Alice L. Zhou, MS,
Laura B. Zeiser, ScM,
Diane Alejo, BA,
Christine M. Durand, MD,
Allan B. Massie, PhD, MHS,
Dorry L. Segev, MD, PhD,
Errol L. Bush, MD,
Ahmet Kilic, MD
Affiliations
Jessica M. Ruck, MD
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
Alice L. Zhou, MS
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
Laura B. Zeiser, ScM
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
Diane Alejo, BA
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
Christine M. Durand, MD
Division of Infection Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
Allan B. Massie, PhD, MHS
Division of Transplant Surgery, Department of Surgery, NYU Langone Health, New York, NY
Dorry L. Segev, MD, PhD
Division of Transplant Surgery, Department of Surgery, NYU Langone Health, New York, NY; Scientific Registry of Transplant Recipients, Minneapolis, Minn
Errol L. Bush, MD
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
Ahmet Kilic, MD
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md; Address for reprints: Ahmet Kilic, MD, Department of Surgery, Johns Hopkins Medical Institutions, Sheikh Zayed Tower, Suite 7107, 1800 Orleans St, Baltimore, MD 21287.
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 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.
