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Outcomes of Heart Transplantation Using Hepatitis C–Positive Donors
Study Questions:
What is the impact of hepatitis C–positive (HCV+) donors on outcomes of heart transplantation in the United States?
Methods:
The study cohort was comprised of adults undergoing isolated orthotopic heart transplantation (OHT) in the United States between January 1, 2016, and December 31, 2018. The primary outcome was 1-year post-transplant survival. All causes of mortality were included in the survival analysis. Secondary outcomes included drug-treated rejection within 1 year of transplantation. All forms of rejection, including antibody-mediated rejection, were included in this outcome. Rates of new-onset postoperative dialysis and postoperative stroke were also compared. For the latter two secondary outcomes, postoperative was defined as occurring during the index hospitalization following transplantation. Length of hospitalization following heart transplantation was an additional secondary outcome. Multivariable Cox regression and 2:1 propensity matching were used to compare outcomes between transplants with HCV+ and hepatitis C–negative (HCV-) donors. The study authors performed a subanalysis to evaluate the impact of nucleic acid amplification test positivity on outcomes.
Results:
Of 7,889 isolated OHTs performed during the study period, 4.4% (n = 343) used HCV+ donors. Overall unadjusted 1-year post-transplant survival was not statistically different between HCV- versus HCV+ donors (91.1% vs. 90.2%; p = 0.86), a finding that persisted after risk adjustment (hazard ratio, 1.05; 95% confidence interval, 0.70–1.58; p = 0.80). Propensity matching resulted in 675 well-balanced patients (437 HCV- and 238 HCV+). Overall 1-year post-transplant survival was not statistically different in propensity-matched analysis (89.8% HCV- vs. 89.2% HCV+; p = 0.88). Rates of 1-year drug-treated rejection (21.1% vs. 22.1%; p = 0.84), postoperative dialysis (11.4% vs. 14.7%; p = 0.22), and stroke (4.6% vs. 2.1%; p = 0.10) were also not statistically different between HCV- and HCV+ groups, respectively. Length of hospitalization was similar in HCV- (median, 16 days; interquartile range, 11–23 days) and HCV+ cases (median, 16 days; interquartile range, 12–24 days) (p = 0.36). Outcomes were not statistically different between nucleic acid amplification test–negative and nucleic acid amplification test–positive HCV+ donors.
Conclusions:
The study authors concluded that 1-year post-transplant survival was comparable to HCV- donors. They also concluded that heart transplants using HCV+ donors are safe and portend excellent survival to patients with end-stage heart failure.
Perspective:
This small retrospective study suggests that HCV+ donors are safe and may be an option in selected patients awaiting OHT. More long-term and prospective data are now needed to make the utilization of HCV+ donors ‘standard of care.’
Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and Heart Failure, Acute Heart Failure, Heart Transplant
Keywords: Cardiac Surgical Procedures, Graft Survival, Heart Failure, Heart Transplantation, Hepacivirus, Hepatitis C, Nucleic Acid Amplification Techniques, Renal Dialysis, Standard of Care, Stroke, Survival Analysis, Treatment Outcome
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