Outcomes of over 1,000 Heart Transplants Using Hepatitis C Positive Donors in the Modern Era

Abstract

<h3>Purpose</h3> Advances in the treatment of hepatitis C (HCV) and an ongoing opioid epidemic have made HCV-positive (HCV+) donor organs increasingly available for transplantation. Recent reports of outcomes after heart transplantation (HT) using HCV+ donors have limited cohort size and follow up. This analysis reports mid-term outcomes of over 1,000 HCV+ HT performed in the United States in the modern era. <h3>Methods</h3> The United Network of Organ Sharing registry was used to identify patients undergoing HT between 2015-2021. Recipients were stratified by donor HCV serostatus and nucleic acid amplification test positivity (NAT+). The primary outcome was one-year mortality. A subanalysis comparing recipients of HCV NAT+ to NAT- organs was performed. Risk-adjustment for mortality was performed using Cox proportional hazards modeling. Kaplan-Meier analysis was used to compare post-HT survival. <h3>Results</h3> There was a significant annual increase in the frequency of HCV+ HT from 1.2% of HT in 2015 to 12.9% in 2021 (<i>p</i> < 0.001). Of 16,648 patients undergoing HT within the study period, 1,170 (7.0%) received an HCV+ organ. Recipients of HCV+ organs were more likely to be HCV seropositive, older, and white. HCV+ donors were more likely to be older, female, and white, and their organs had significantly longer cold ischemic times. In multivariable analysis, the adjusted risk for one-year mortality for an HCV+ donor was 0.87 (95% CI [0.69-1.10], <i>p</i> = 0.242). Of 1,170 HCV+ HT, 772 (61.7%) were NAT+. The adjusted risk for one-year mortality in a NAT+ HT was 0.73 (95% CI [0.47-1.13] <i>p</i> = 0.159) compared to NAT- HT. Unadjusted 3-year survival was 84.9%, 81.5%, and 85.5% in HCV-, HCV+NAT-, and HCV+ NAT+, respectively (<i>p</i> = 0.374) (Figure). <h3>Conclusion</h3> The annual proportion of HT using HCV+ donors has increased over ten-fold in the last six years. This analysis of the United States experience demonstrates that recipients of HCV+ hearts, including those that are NAT+, have acceptable outcomes with similar mid-term survival as HCV- cases.