Impact of Donor Hepatitis C Viremia on Acute Rejection in Heart Transplant Recipients

Abstract

<h3>Purpose</h3> With the advent of direct acting antivirals, hepatitis C viremic donors are being increasingly used for heart transplantation. Single institutions have reported increased incidence of acute rejection when utilizing these hearts. The goal of this study was to evaluate one-year acute rejection following heart transplant from HCV viremic donors. <h3>Methods</h3> We conducted retrospective review of UNOS of all primary adult heart transplants conducted between March 31, 2015 and June 30, 2020, excluding recipients with prior transplants, multiorgan transplants, or those waitlisted for other organs. Donors were dichotomized as being HCV NAT+ or HCV NAT-. One-year acute rejection requiring treatment was compared and evaluated by univariable and multivariable logistic regression. <h3>Results</h3> Of 11,058 heart transplant recipients in our cohort during the study period, 432 (3.9%) came from HCV NAT+ donors. HCV NAT+ donors were significantly older (34±8 vs 32±11 years, p<0.01), more likely to be white (82% vs 64%, p<0.01), blood group O (61% vs 49%, p<0.01), CDC high risk (88% vs 30%, p<0.01), and have drug use as cause of death (61% vs 17%, p<0.01). Recipients in the HCV NAT+ group were older [58(49-64) vs 56 (46-63) years, p<0.01), had higher ischemic times (3.5±1.0 vs 3.1±1.1 hours, p<0.01) and were more likely to be blood group O (49% vs 39%, p<0.01) and HCV antibody positive (5% vs 2%, p<0.01). They were less likely to be on inotropes (31% vs 37%, p<0.01) or any life support (81% vs 86%, p<0.01) at the time of transplant. Incidence of acute rejection requiring treatment within one year was not significantly different between the two groups (21% HCV NAT+ vs 19% HCV NAT-, p = 0.31). Donor HCV NAT+ was not associated with one-year acute rejection on either univariable (OR 1.13, 95% CI 0.89-1.43) or multivariable (aOR 1.08, 95% CI 0.84-1.41) logistic regression. <h3>Conclusion</h3> Despite single center studies reporting potential increases in acute rejection when utilizing HCV-viremic donor hearts for transplantation, our UNOS registry analysis did not demonstrate increased treatment for acute rejection after one year. We should continue to utilize these donor hearts with careful surveillance and monitoring of long-term outcomes.