Utilization rates and clinical outcomes of hepatitis C positive donor hearts in the contemporary era

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Abstract

BACKGROUND: Hepatitis C virus (HCV) donors should be categorized as HCV-viremic (antibody [Ab] negative or positive/Nucleic Acid testing [NAT] positive) or HCV Ab+ nonviremic (Ab+/NAT). Whereas recipients of hearts from HCV-viremic donors will develop viremia but can be cured of HCV shortly after transplant with direct-acting antivirals (DAAs), recipients of hearts from HCV Ab+ nonviremic donors are highly unlikely to become viremic or require DAAs. Given this important difference in risk, we assessed the utilization trends and post-heart-transplantation outcomes of HCV-naive (Ab/NAT), HCV-viremic, and HCV Ab+ nonviremic donor hearts. METHODS: A total of 26,572 adult donors (≥18 years) with information on HCV Ab and NAT status were identified in the United Network for Organ Sharing registry between August 2015 and June 2018 for utilization rates. Adult heart transplant recipients of these donors were compared for primary graft failure (PGF) at 90 days and 1-year recipient survival. RESULTS: A total of 96 HCV Ab+ nonviremic and 135 HCV-viremic adult donor hearts were transplanted during the study period. The utilization rates of both HCV Ab+ nonviremic (1.4%–23.4%) and HCV-viremic (0.7%–25.4%) donor hearts increased significantly approaching HCV-naive rates (29.04%). There was no significant difference in rates of PGF and 1-year survival between recipients in the 3 donor HCV groups. We also used (1:3) propensity score matching and found similar 1-year survival in different donor HCV groups (HCV-naive vs HCV Ab+ nonviremic, p = 0.59, and HCV-naive vs HCV-viremic, p = 0.98). CONCLUSIONS: Recipients of HCV-viremic and HCV Ab+ nonviremic donor hearts had equivalent risk of PGF and 1-year mortality compared with recipients of HCV-naive donor hearts. Although only HCV-viremic organs require DAAs and the risk of coronary artery vasculopathy after treated HCV infection has not been defined, the utilization rates of both HCV Ab+ nonviremic and HCV-viremic adult donor hearts have increased at an equal pace now approaching HCV-naive rates.

Original languageEnglish (US)
Pages (from-to)907-917
Number of pages11
JournalJournal of Heart and Lung Transplantation
Volume38
Issue number9
DOIs
StatePublished - Sep 1 2019

Fingerprint

Hepatitis C
Hepacivirus
Hepatitis C Antibodies
Tissue Donors
Nucleic Acids
Antiviral Agents
Transplants
Survival
Propensity Score
Viremia
Virus Diseases
Heart Transplantation

Keywords

  • donor shortage
  • HCV
  • Heart Transplantation
  • Hepatitis C donor
  • Hepatitis C Viremia

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

@article{65c60f0459f949929b180fd0e71f84e8,
title = "Utilization rates and clinical outcomes of hepatitis C positive donor hearts in the contemporary era",
abstract = "BACKGROUND: Hepatitis C virus (HCV) donors should be categorized as HCV-viremic (antibody [Ab] negative or positive/Nucleic Acid testing [NAT] positive) or HCV Ab+ nonviremic (Ab+/NAT–). Whereas recipients of hearts from HCV-viremic donors will develop viremia but can be cured of HCV shortly after transplant with direct-acting antivirals (DAAs), recipients of hearts from HCV Ab+ nonviremic donors are highly unlikely to become viremic or require DAAs. Given this important difference in risk, we assessed the utilization trends and post-heart-transplantation outcomes of HCV-naive (Ab–/NAT–), HCV-viremic, and HCV Ab+ nonviremic donor hearts. METHODS: A total of 26,572 adult donors (≥18 years) with information on HCV Ab and NAT status were identified in the United Network for Organ Sharing registry between August 2015 and June 2018 for utilization rates. Adult heart transplant recipients of these donors were compared for primary graft failure (PGF) at 90 days and 1-year recipient survival. RESULTS: A total of 96 HCV Ab+ nonviremic and 135 HCV-viremic adult donor hearts were transplanted during the study period. The utilization rates of both HCV Ab+ nonviremic (1.4{\%}–23.4{\%}) and HCV-viremic (0.7{\%}–25.4{\%}) donor hearts increased significantly approaching HCV-naive rates (29.04{\%}). There was no significant difference in rates of PGF and 1-year survival between recipients in the 3 donor HCV groups. We also used (1:3) propensity score matching and found similar 1-year survival in different donor HCV groups (HCV-naive vs HCV Ab+ nonviremic, p = 0.59, and HCV-naive vs HCV-viremic, p = 0.98). CONCLUSIONS: Recipients of HCV-viremic and HCV Ab+ nonviremic donor hearts had equivalent risk of PGF and 1-year mortality compared with recipients of HCV-naive donor hearts. Although only HCV-viremic organs require DAAs and the risk of coronary artery vasculopathy after treated HCV infection has not been defined, the utilization rates of both HCV Ab+ nonviremic and HCV-viremic adult donor hearts have increased at an equal pace now approaching HCV-naive rates.",
keywords = "donor shortage, HCV, Heart Transplantation, Hepatitis C donor, Hepatitis C Viremia",
author = "Shivank Madan and Patel, {Snehal R.} and Kusha Rahgozar and Omar Saeed and Sandhya Murthy and Sasa Vukelic and Sims, {Daniel B.} and Shin, {Jooyoung Julia} and Goldstein, {Daniel J.} and Jorde, {Ulrich P.}",
year = "2019",
month = "9",
day = "1",
doi = "10.1016/j.healun.2019.06.023",
language = "English (US)",
volume = "38",
pages = "907--917",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",
number = "9",

}

TY - JOUR

T1 - Utilization rates and clinical outcomes of hepatitis C positive donor hearts in the contemporary era

AU - Madan, Shivank

AU - Patel, Snehal R.

AU - Rahgozar, Kusha

AU - Saeed, Omar

AU - Murthy, Sandhya

AU - Vukelic, Sasa

AU - Sims, Daniel B.

AU - Shin, Jooyoung Julia

AU - Goldstein, Daniel J.

AU - Jorde, Ulrich P.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - BACKGROUND: Hepatitis C virus (HCV) donors should be categorized as HCV-viremic (antibody [Ab] negative or positive/Nucleic Acid testing [NAT] positive) or HCV Ab+ nonviremic (Ab+/NAT–). Whereas recipients of hearts from HCV-viremic donors will develop viremia but can be cured of HCV shortly after transplant with direct-acting antivirals (DAAs), recipients of hearts from HCV Ab+ nonviremic donors are highly unlikely to become viremic or require DAAs. Given this important difference in risk, we assessed the utilization trends and post-heart-transplantation outcomes of HCV-naive (Ab–/NAT–), HCV-viremic, and HCV Ab+ nonviremic donor hearts. METHODS: A total of 26,572 adult donors (≥18 years) with information on HCV Ab and NAT status were identified in the United Network for Organ Sharing registry between August 2015 and June 2018 for utilization rates. Adult heart transplant recipients of these donors were compared for primary graft failure (PGF) at 90 days and 1-year recipient survival. RESULTS: A total of 96 HCV Ab+ nonviremic and 135 HCV-viremic adult donor hearts were transplanted during the study period. The utilization rates of both HCV Ab+ nonviremic (1.4%–23.4%) and HCV-viremic (0.7%–25.4%) donor hearts increased significantly approaching HCV-naive rates (29.04%). There was no significant difference in rates of PGF and 1-year survival between recipients in the 3 donor HCV groups. We also used (1:3) propensity score matching and found similar 1-year survival in different donor HCV groups (HCV-naive vs HCV Ab+ nonviremic, p = 0.59, and HCV-naive vs HCV-viremic, p = 0.98). CONCLUSIONS: Recipients of HCV-viremic and HCV Ab+ nonviremic donor hearts had equivalent risk of PGF and 1-year mortality compared with recipients of HCV-naive donor hearts. Although only HCV-viremic organs require DAAs and the risk of coronary artery vasculopathy after treated HCV infection has not been defined, the utilization rates of both HCV Ab+ nonviremic and HCV-viremic adult donor hearts have increased at an equal pace now approaching HCV-naive rates.

AB - BACKGROUND: Hepatitis C virus (HCV) donors should be categorized as HCV-viremic (antibody [Ab] negative or positive/Nucleic Acid testing [NAT] positive) or HCV Ab+ nonviremic (Ab+/NAT–). Whereas recipients of hearts from HCV-viremic donors will develop viremia but can be cured of HCV shortly after transplant with direct-acting antivirals (DAAs), recipients of hearts from HCV Ab+ nonviremic donors are highly unlikely to become viremic or require DAAs. Given this important difference in risk, we assessed the utilization trends and post-heart-transplantation outcomes of HCV-naive (Ab–/NAT–), HCV-viremic, and HCV Ab+ nonviremic donor hearts. METHODS: A total of 26,572 adult donors (≥18 years) with information on HCV Ab and NAT status were identified in the United Network for Organ Sharing registry between August 2015 and June 2018 for utilization rates. Adult heart transplant recipients of these donors were compared for primary graft failure (PGF) at 90 days and 1-year recipient survival. RESULTS: A total of 96 HCV Ab+ nonviremic and 135 HCV-viremic adult donor hearts were transplanted during the study period. The utilization rates of both HCV Ab+ nonviremic (1.4%–23.4%) and HCV-viremic (0.7%–25.4%) donor hearts increased significantly approaching HCV-naive rates (29.04%). There was no significant difference in rates of PGF and 1-year survival between recipients in the 3 donor HCV groups. We also used (1:3) propensity score matching and found similar 1-year survival in different donor HCV groups (HCV-naive vs HCV Ab+ nonviremic, p = 0.59, and HCV-naive vs HCV-viremic, p = 0.98). CONCLUSIONS: Recipients of HCV-viremic and HCV Ab+ nonviremic donor hearts had equivalent risk of PGF and 1-year mortality compared with recipients of HCV-naive donor hearts. Although only HCV-viremic organs require DAAs and the risk of coronary artery vasculopathy after treated HCV infection has not been defined, the utilization rates of both HCV Ab+ nonviremic and HCV-viremic adult donor hearts have increased at an equal pace now approaching HCV-naive rates.

KW - donor shortage

KW - HCV

KW - Heart Transplantation

KW - Hepatitis C donor

KW - Hepatitis C Viremia

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U2 - 10.1016/j.healun.2019.06.023

DO - 10.1016/j.healun.2019.06.023

M3 - Article

C2 - 31495408

AN - SCOPUS:85070526858

VL - 38

SP - 907

EP - 917

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

IS - 9

ER -