HCV-positive donor hearts confer similar outcomes to HCV-negative hearts
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Patients who received a hepatitis C virus-positive donor heart experienced similar posttransplant survival, drug-treated rejection, postoperative dialysis and stroke incidence to patients whose transplant heart was from a HCV-negative donor.
According to findings published in the Journal of the American Heart Association, after an analysis of 7,889 heart transplants, of which 4.4% used HCV-positive donors, researchers observed no significant difference in the primary outcome of 1-year posttransplant survival (HCV-negative, 91.1%; HCV-positive, 90.2%; P = .86). This finding remained consistent after risk adjustment (HR = 1.05; 95% CI, 0.7-1.58).
In a subsequent propensity-matched analysis of 675 patients, researchers found no statistically significant difference between HCV-negative and HCV-positive transplant outcomes, including:
- 1-year posttransplant survival (HCV-negative, 89.8%; HCV-positive, 89.2%; P = .88);
- rates of 1-year drug-treated rejection (HCV-negative, 21.1%; HCV-positive, 22.1%; P = .84);
- postoperative dialysis (HCV-negative, 11.4%; HCV-positive, 14.7%; P = .22); and
- stroke (HCV-negative, 4.6%; HCV-positive, 2.1%; P = .1).
“These findings demonstrate using national data that heart transplants performed using hepatitis C-positive donors are safe and have comparable outcomes in recipients as those transplants performed not using hepatitis-C positive donors,” Arman Kilic, MD, assistant professor of cardiothoracic surgery, director of surgery quality and analytics and co-director of the Center for Cardiovascular Outcomes and Innovation at the University of Pittsburgh Medical Center, told Healio. “This research is important in that it addresses the Achilles’ heel of heart transplantation — donor shortages — and provides a relatively straightforward manner in which we as a transplant community can help tackle this persistent problem of providing transplantation to more patients in need.”
In other findings, outcomes were not statistically different between nucleic acid amplification test (NAT)-negative and NAT-positive HCV-positive donors.
Using data gathered from the United Network for Organ Sharing (UNOS) registry of adult heart transplant recipients between 2016 and 2018, researchers aimed to assess the effect of HCV-positive donors on outcomes of heart transplantation in the U.S.
“There should be active efforts to educate not only the public, but also other transplant centers not utilizing hepatitis C-positive donors, as to these outcomes. Efforts at recruiting possible donors should mention that hepatitis C positivity by itself is not necessarily an exclusion criteria for being a donor, and that outcomes of heart transplantation for example seem to be unaffected by hepatitis C status,” Kilic said in an interview. “Longer-term follow-up using national data is needed. In addition, more granular details related to the use of hepatitis C-positive donors such as rates of seroconversion and center-specific protocols need to continue to be reviewed and optimized.” – by Scott Buzby
Disclosures: Kilic and another author report they are members of the medical advisory board for Medtronic. The other authors report no relevant financial disclosures.
Perspective
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These data on the initial national experience with the use of HCV-positive donor hearts are reassuring. The 1-year patient outcomes are similar to those seen for patients with HCV-negative hearts. However, we will need data on longer-term survival and the potential increased risk for the development of vasculopathy before we know the full impact of this therapeutic choice. Overall, the use of HCV-positive donors has expanded the donor pool significantly and has allowed for lifesaving transplantation for many more patients.
HCV-positive individuals should be encouraged to both seek treatment for their disease and not hesitant to register as donors. Their organs can be part of saving lives.
This analysis includes all transplants done over a 2-year period (2016 to 2018). In the past year, many more transplant centers have begun accepting HCV-positive donor hearts. The outcomes of this growing group of patients will need to be followed closely.
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