Early Utilization Trends and Outcomes of Hepatitis C Donor Hearts in the Era of Nucleic Acid Amplification Testing (NAT) and Direct Acting Antivirals (DAAs)

Abstract

Purpose The American Society of Transplantation has recently called for better risk stratification of donor hearts based on hepatitis C virus (HCV) antibody (Ab)/NAT status, advised to consider NAT negative (non-viremic) hearts noninfectious, and underscored the need for more research before HCV NAT+ (viremic) hearts can be used routinely. We examined early trends in utilization rates and outcomes of HCV donor hearts based on Ab and NAT status. Methods Between 8/2015 and 6/2018, we identified 29,225 donors with HCV Ab/NAT status and organ disposition in UNOS (for utilization trends). After excluding multi-organ and re-transplants, 7260 adult heart transplantation (HT) recipients were used to analyze baseline donor/recipient characteristics and outcomes in different donor HCV Ab/NAT categories. Results During the study period, the acceptance rates for HCV Ab+/NAT- donor hearts increased from 1.4% to 23.4%, Ab+/NAT+ from 0.6% to 26.0% and Ab-/NAT+ from 0% to 9.1% (p Conclusion Even though infectious risk starkly differs and long-term outcomes are unclear in the era of DAAs, we found a significant and near identical increase in utilization of both HCV viremic (NAT+) and non-viremic (Ab+/NAT-) donor hearts. Early survival was similar to recipients of HCV Ab-/NAT- donor hearts.