Impact of Donor-Transmitted Hepatitis C Virus on Development of Early Cardiac Allograft Vasculopathy in the Current Era

Abstract

<h3>Purpose</h3> Rates of heart transplantation (HT) from hepatitis C virus (HCV)-infected donors have recently increased significantly. While historical data suggest that donor-transmitted HCV (dt-HCV) may be associated with higher rates of cardiac allograft vasculopathy (CAV), the impact of dt-HCV on development of CAV in the current era remains unclear. <h3>Methods</h3> We performed a retrospective review of adults undergoing HT at our institution between September 2016 and December 2020 who had coronary angiography +/- intravascular ultrasound (IVUS) performed at least once for CAV surveillance. Kaplan-Meier and multivariable Cox proportional hazards models tested whether CAV-free survival (ISHLT grade ≥ 2 and ≥ 1) differed over the first post-HT year between patients transplanted with HCV-infected donors (HCV+ recipients) and those who were not (HCV- recipients). The incidence of rapidly progressive CAV (RPC), defined as increase in maximum intimal thickness ≥ 0.5 mm, was compared between groups using Fisher's Exact test. <h3>Results</h3> Among 83 HCV+ recipients compared with 162 HCV- recipients, there were no significant differences in donor age or age at HT. HCV+ recipients were less likely to be treated for rejection within the first post-HT year (16.9% vs. 32.1%, p = 0.014). Survival free of CAV ≥ 2 did not differ over the first year (p = 0.555) whereas survival free of CAV ≥ 1 was lower among HCV+ recipients (Figure, p = 0.002), even after adjusting for donor age and treated rejection (HR 2.9, 95% CI 1.4 to 5.8). Among 121 patients who underwent IVUS at baseline and 1-year, incidence of RPC was greater among HCV+ than among HCV- recipients (33.9% vs. 16.1%, p = 0.034). <h3>Conclusion</h3> In our single center study, the largest of its kind, HT from HCV-infected donors was associated with higher incidence of RPC and reduced survival free of CAV ≥ 1 but similar survival free of CAV ≥ 2 over the first post-HT year. Longer-term studies are needed to evaluate the impact of dt-HCV on rates of CAV and survival after the first post-HT year.