JTCVS Open (Dec 2022)

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

Journal volume & issue
Vol. 12
pp. 269 – 279

Abstract

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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.

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