Temporal and Regional Trends in Heart Transplantation from Hepatitis C Donors

Abstract

Background In the past, donors with hepatitis C (HCV) viremia were rarely accepted for orthotopic heart transplantation (HT) due to post-transplantation risks. A successful cure, the opiate epidemic and the shortage of available donors have led to a paradigm shift with increasing HT from HCV donors. We sought to examine the temporal and regional trends utilizing a national database. Methods We utilized the Scientific Registry of Transplant Recipients (SRTR) to identify adult HT from HCV donors from October 1987 to August 2018. Patients listed for combined organ transplantations were excluded. Results 7950 HCV donors were made available resulting in 589 HT (7.7%) from HCV donors accounting for 0.95% (589/61692) of all adult HTs during the study period. These 589 HCV donors were predominantly male (75%), Caucasian (87%) with a mean age 35.7 (± 9.5) years and drug intoxication as the most common mechanism of death (30.7%). An average of 32 annual HT from HCV donors were performed between 1994 and 2002. This trend decreased to an average of 3 annual HT from HCV donors between 2003 and 2015. However, a rising trend was noted from 2015 onwards with 146 HT from HCV donors in 2018 (146/1966, 7.4%) (Figure 1). The largest number of HCV donors came from the North East region (272/589, 46.2%) with the highest number of HCV donors coming from the state of Pennsylvania (11.2%) (Figure 2). Conclusions There is a rising trend in adult HT from HCV donors, although utilization varied between regions. Regional variation suggests a potential to improve heart acceptance rates in under-performing regions supported by research and policy efforts.