Utilization of hepatitis C virus infected donors in heart transplant recipients with elevated MELD-XI score.

Abstract

The advent of direct-acting antivirals has helped to increase the safe utilization of organs from hepatitis C virus positive (HCV+) donors. However, the outcomes of heart transplantation (HT) using an HCV+ donor are unclear in recipients with underlying liver disease represented by an elevated model for end-stage liver disease excluding international normalized ratio (MELD-XI). The United Network of Organ Sharing database was queried from Jan 2016 to Dec 2021. Post-transplant outcomes stratified by recipient MELD-XI score (low<10.37, medium, 10.38-13.39, and high>13.4) was compared between patients with HT from HCV+ (N=792) and patients with HT from HCV-negative donors (N=15,266). The median MELD-XI score was comparable (HCV+, 12.1, vs. HCV-negative, 11.8, p=.37). In the HCV+ group, donors were older (33vs. 31 years, p<.001). Ischemic time of donor hearts (3.48vs. 3.28h, p<.001) and travel distance (250vs. 157 miles, p<.001) were longer in HCV+ group. In the Kaplan Meier analysis with a median follow-up of 750 days, survival was comparable between the two groups (2-year survival, MELD-XI Low: HCV+, 92.4±3.6% vs. HCV-negative, 91.1±.8%, p=.83, Medium: HCV+ 89.2±4.3% vs. HCV-negative, 88.2±1.0%, p=.68, and High: HCV+, 84.9±4.5% vs. HCV-negative, 84.6±1.1%, p=.75) In multivariate Cox hazard models, HCV donors were not associated with mortality in each MELD-XI subgroup (Low: adjusted hazard ratio (aHR), 1.02, p=.94; Medium: aHR, .95, p=.81; and High: aHR, .93, p=.68). Utilization of HCV+ hearts was not associated with an increased risk of adverse outcomes in recipients with an elevated MELD- XI score.