Abstract
For patients awaiting heart transplantation (HT), hepatitis C virus (HCV)-positive donors offer to expand the donor pool, shorten wait times and decrease wait list mortality. While early reported outcomes have been promising, knowledge of 1-year outcomes in larger cohorts of patients remains unclear. Between September 2016 and September 2019, 96 patients underwent HT from HCV-positive donors, 83 of whom were viremic at time of organ recovery. All patients were treated with standard immunosuppression and, for those who developed donor-derived HCV (dd-HCV), with a course of direct-acting antiviral (DAA) therapy. Data collection and analysis were performed after obtaining IRB approval and informed patient consent. Baseline characteristics: Mean age of recipients at time of HT was 52 ± 12 years (72% male, 68% Caucasian, 44% on left ventricular assist device support). Mean age of donors was 32 ± 7 years. Among donors, results of HCV antibody (Ab) and nucleic acid testing (NAT) were: 80 Ab+/NAT+, 13 Ab+/NAT-, 3 Ab-/NAT+. Time to transplant: Among all patients, median active waitlist time from consent to acceptance of HCV-positive donors was 4 days (IQR 1, 17). Hepatitis C testing and treatment: No recipients of NAT- donor hearts developed HCV infection. Of 83 patients who received NAT+ donor hearts, 80 (96.4%) developed dd-HCV. Treatment with DAA therapy was well tolerated and yielded sustained virologic responses in 100% of treated patients (n=52, to date). Survival: Among 80 patients with dd-HCV, survival at 30-days and 1-year post-HT was 91.2% and 88.3%, respectively, not significantly different when compared to patients transplanted with HCV-negative donors during the same time frame (30-day survival 96%, p=0.10; 1-year survival 91.6%, p=0.27). In the era of direct-acting antiviral therapies, hepatitis C-positive donors are a viable strategy to expand the donor pool, potentially reducing waitlist duration and mortality.
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