Trends and three-year outcomes of hepatitis C virus-viremic donor heart transplant for hepatitis C virus-seronegative recipients

Jessica M Ruck; Alice L Zhou; Laura B Zeiser; Diane Alejo; Christine M Durand; Allan B Massie; Dorry L Segev; Errol L Bush; Ahmet Kilic

doi:10.1016/j.xjon.2022.10.007

Trends and three-year outcomes of hepatitis C virus-viremic donor heart transplant for hepatitis C virus-seronegative recipients

JTCVS Open. 2022 Nov 3:12:269-279. doi: 10.1016/j.xjon.2022.10.007. eCollection 2022 Dec.

Authors

Jessica M Ruck¹, Alice L Zhou¹, Laura B Zeiser¹, Diane Alejo¹, Christine M Durand², Allan B Massie³, Dorry L Segev^{3

4}, Errol L Bush¹, Ahmet Kilic¹

Affiliations

¹ Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
² Division of Infection Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
³ Division of Transplant Surgery, Department of Surgery, NYU Langone Health, New York, NY.
⁴ Scientific Registry of Transplant Recipients, Minneapolis, Minn.

Abstract

Objective: Heart transplants (HTs) from hepatitis C virus (HCV)-viremic donors to HCV-seronegative recipients (HCV D+/R-) have good 6-month outcomes, but practice uptake and long-term outcomes overall and among candidates on mechanical circulatory support (MCS) have yet to be established.

Methods: Using the Scientific Registry of Transplant Recipients, we identified US adult HCV-seronegative HT recipients (R-) from 2015 to 2021. We classified donors as HCV-seronegative (D-) or HCV-viremic (D+). We used multivariable regression to compare post-HT extracorporeal membranous oxygenation, dialysis, pacemaker, acute rejection, and risk of post-HT mortality between HCV D+/R- and HCV D-/R-. Models were adjusted for donor, recipient, and transplant characteristics and center HT volume. We performed subgroup analyses of recipients bridged with MCS.

Results: From 2015 to 2021, the number of HCV D+/R- HT increased from 1 to 181 and the number of centers performing HCV D+/R- HT increased from 1 to 60. Compared with HCV D-/R- recipients, HCV D+/R- versus D-/R- recipients overall and among patients bridged with MCS had similar odds of post-HT extracorporeal membranous oxygenation, dialysis, pacemaker, and acute rejection; and mortality risk at 30 days, 1 year, and 3 years (all P > .05). High center HT volume but not HCV D+/R- volume (<5 vs >5 in any year) was associated with lower mortality for HCV D+/R- HT.

Conclusions: HCV D+/R- and D-/R- HT have similar outcomes at 3 years' posttransplant. These results underscore the opportunity provided by HCV D+/R- HT, including among the growing population bridged with MCS, and the potential benefit of further expanding use of HCV+ allografts.

Keywords: D+, HCV-viremic donor; DAAs, direct-acting antivirals; DCD, donation after circulatory death; D–, HCV-seronegative donor; ECMO, extracorporeal membranous oxygenation; HCV, hepatitis C virus; HT, heart transplant; IABP, intra-aortic balloon pump; IQR, interquartile range; LVAD, left ventricular assist device; MCS, mechanical circulatory support; R–, HCV-seronegative recipient; SRTR, Scientific Registry of Transplant Recipients; aHR, adjusted hazard ratio; aOR, adjusted odds ratio; donor pool; heart transplant; hepatitis C; outcomes.

Grants and funding

F32 AG067642/AG/NIA NIH HHS/United States