Hepatitis C Donors Are Not Associated with Higher Rates of Rejection After Cardiac Transplantation

Abstract

<h3>Purpose</h3> Utilization of Hepatitis C (HCV) donors has led to a rapid expansion of the heart donor pool. Short term safety as measured by one year mortality has been published, however data on morbidity is lacking. We leveraged the multi-center SHORE registry to compare surrogate markers for outcomes in recipients of HCV+ vs HCV- donors. <h3>Methods</h3> The SHORE registry was queried for all heart transplant recipients with known donor status of HCV. Baseline characteristics were compared between recipients of HCV+ and HCV- donors. Since the registry does not differentiate between HCV viremic and non-viremic, the HCV+ donor group was inclusive of both. Outcomes of interest were rejection defined as ISHLT ≥ 2R and/or AMR ≥ 1 and average AlloSure levels during the first year. We also compared a composite outcome of de novo DSA, rejection, decline in LVEF, and/or development of CAV at one year. <h3>Results</h3> There were 1372 recipients of HCV- and 140 HCV+ donors. Baseline characteristics including age, sex, race and pre-transplant PRA were well matched. Over the first year, incidence of rejection was similar between groups 6.9% vs 4.3% (p=0.32). AlloSure levels over the first year were similar in the HCV- group and HCV+ groups (0.05 (0.0,8.36) vs 0.05 (0.0, 6.4)). Finally, the cumulative incidence of the composite outcome was not different between groups (Fig 1). <h3>Conclusion</h3> In this large analysis of recipients of HCV+ donor hearts, we did not find differences in the rates of rejection or clinically significant differences in levels of AlloSure in the first year. Similarly, the incidence of a composite outcome at one year was not different. These findings should reassure the community on short term safety of HCV+ donors.