A recent study by Dr. Kilic, published in the American Heart Association Journal, showed similar adverse outcomes in the 1-year survival, rejection rates, and complications of patients who received a heart transplant using hepatitis C-positive (HCV+) donors whereas those using hepatitis C-negative donors.
Previous research on the short and long-term effects of hepatitis C infected donors on heart transplant survival showed unfavorable results and a higher mortality rate attributable to liver disease and coronary allograft involvement. However, with the use of direct-acting antiviral drugs in the management of HCV infection and improved post-transplant survival, the desire for using HCV+ donors in heart transplantation has again increased.
In a large, multicenter, cohort study, a total of 7889 isolated heart transplants were done, including 343 (4.4%) using HCV+ donors. The study was performed in a period beginning from January 1, 2016 to December 31, 2018. HCV status was determined based on the HCV antibody positivity and nucleic acid amplification testing (NAT). One-year post-transplant survival was the primary outcome. Secondary outcomes included all forms of rejection (including drug-treated rejection), new-onset postoperative dialysis, and postoperative stroke. To further address the baseline differences among the participants, the authors also did a propensity-matched analysis. Another subanalysis evaluated outcomes of heart transplants using NAT+ versus NAT- HCV+ donors.
Baseline demographic characteristics of HCV+ donors were significantly different from HCV- donors in terms of age, race, blood group, and serum creatinine level. There were also significant differences among heart recipients’ demographic characteristics. In the unmatched analysis, HCV serostatus was associated with no adverse outcome at a 1-year post-transplant survival rate, even after risk adjustment (hazard ratio, 1.05; 95% CI, 0.70 – 1.58; P = 0.80). In the propensity matching of the study participants with 675 well-balanced patients (437 HCV- and 238 HCV+), 1-year post-transplant survival rate (89.8% HCV- versus 89.2% HCV+; P = 0.88), 1-year drug-treated rejection rate (HCV-, 21.1% versus HCV+, 22.1%; P = 0.84), new-onset postoperative dialysis (HCV-, 11.4% versus HCV+, 14.7%; P = 0.22), and stroke (HCV-, 4.6% versus HCV+, 2.1%; P = 0.10) were not significantly different between the HCV- and HCV+ recipients. When comparing NAT- HCV+ with NAT+ HCV+ donors, or NAT+ HCV+ donors to HCV- donors, the results remained similar and no statistically significant differences were observed in the primary and secondary outcomes.
This study was limited by the number of patients, particularly after the propensity-matching and the results of this study should further be validated in future studies. Also, studies with specific protocols are needed to evaluate the effects of HCV donor positivity on the recipient’s long-term survival rate and complications as well as the timing of screening for HCV seroconversion, initiation of medical therapy, and adverse side effects of therapy.