Racial and Gender Disparities in Transplantation of Hepatitis C+ Hearts and Lungs

Abstract

BackgroundTransplanting organs from hepatitis c virus (HCV) infected donors into HCV-negative recipients has led to thousands of more transplants in the US since 2016. Studies have demonstrated disparities in utilization of kidneys from these donors due to gender and education. It is still unknown, however, if the same disparities are seen in heart and lung transplantation. MethodsWe used Organ Procurement and Transplantation (OPTN)/United Network for Organ Sharing (UNOS) data on all isolated heart and lung transplants from 11/01/2018- 03/31/2023, classifying donors based on their HCV nucleic acid test (NAT) result: HCV NAT- vs HCV NAT+. We fit separate mixed effects logistic regression models (outcome: HCV-NAT+ donor) for heart and lung transplants. Primary covariates included: 1) race/ethnicity; 2) sex; 3) education level; 4) insurance type; and 5) transplant year. ResultsThe study included 26,108 adults (14,189 isolated heart transplant recipients and 11,919 isolated lung transplant recipients). 993 (7.0%) heart transplants involved an HCV-NAT+ donor, compared to 457 (3.8%) lung transplants. In multivariable models among all isolated heart transplant recipients, women were significantly less likely to receive an HCV-NAT+ donor heart (OR: 0.79, 95% CI: 0.67-0.92, P=0.003), as were Asian patients (OR: 0.52, 95% CI: 0.31=0.86, P= 0.01). In multivariable models among all isolated lung transplant recipients, Asians were significantly less likely to receive HCV-NAT+ transplants (OR: 0.31, 95% CI: 0.12-0.77, P= 0.01). ConclusionThere are disparities in utilization of heart and lungs from HCV NAT+ donors, with women and Asian patients being significantly less likely to receive these transplants.