Factors Influencing Acceptance and Transplantation of Hearts from Hepatitis C+ Donors

Abstract

<h3>Purpose</h3> This study investigates reasons for rejection of hearts from Hepatitis C+ donors, and predictive factors for acceptance and transplantation. <h3>Methods</h3> The United Network for Organ Sharing deceased donor registry was queried for adult donors with offers for heart donation from 2015-2020. We excluded patients from whom consent was not obtained or received, and incomplete data. HCV status was determined by nucleic acid testing (NAT). <h3>Results</h3> A total of 49,045 HCV- and 3,136 HCV+ donors were consented for heart donation from 2015-2020. HCV+ donors were younger (38.5 vs 43.5 years, p<0.001) with fewer comorbidities (p<0.001 for all): myocardial infarct (2.9% vs 4.6%), coronary artery disease (2.6% vs 7.0%), diabetes (6.3% vs 13.6%), and hypertension (23.9% vs 38.8%). The most common mechanism of death was stroke (30.1%) in HCV- donors and drug overdose (48.4%) in HCV+ donors. HCV+ donors were less likely to undergo recovery of the heart (20.0% vs 30.4%, p<0.001) and eventual transplantation (19.9% vs. 30.1%, p<0.001). HCV- organs were more often refused due to organ quality (HCV+: 21.0% vs HCV-:24.8%) or recovered and discarded (HCV+: 1.3% vs HCV-: 13.9%), while HCV+ hearts were more likely to be unused due to lack of recipient or accepting institution (25.0% vs 5.6%, p<0.001). Hepatitis was the primary reason for refusal in 12.2% of HCV+ donors. On multivariable analysis, HCV+ status was an independent negative predictor of acceptance and transplantation (OR 0.32, p<0.001). Negative predictors include age (OR 0.93, p<0.001), history of MI (OR 0.53, p<0.001), coronary artery disease (OR 0.11, p<0.001), diabetes (OR 0.57, p<0.001), smoking history (OR 0.84, p<0.001), chest trauma (OR 0.82, p<0.001), and cardiovascular mechanism of death (OR 0.71, p<0.001). <h3>Conclusion</h3> HCV+ hearts were less likely to be recovered and transplanted despite lower rates of cardiovascular comorbidities. Reasons for discard were primarily unrelated to organ quality or function, and may reflect ongoing skepticism in use of HCV+ organs.