The impact of using hepatitis c virus nucleic acid test–positive donor hearts on heart transplant waitlist time and transplant rate

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BACKGROUND

Previous studies suggest that direct-acting anti-virals (DAAs) for the treatment of hepatitis C virus (HCV) infection permits the transplantation of HCV-viremic donor organs in uninfected recipients. This opportunity may expand the donor pool. We assessed the impact of using HCV nucleic acid test–positive (NAT+) donor hearts on heart transplant (HTx) waitlist time and transplant rate.

METHODS

We retrospectively analyzed 156 patients who were listed for HTx from October 2015 through October 2018. Patients were stratified into 2 periods centered on April 27, 2017, when the protocol to accept HCV NAT+ donor organs for transplantation in non–HCV-infected recipients began, Period 1 (October 27, 2015 to April 26, 2017) and Period 2 (April 27, 2017 to October 26, 2018).

RESULTS

In Period 1, 57 of the 71 patients on the HTx waitlist were transplanted, whereas in Period 2, 57 of the 85 patients were transplanted. The median waitlist time to transplant decreased from 63.1 days in Period 1 to 34.1 days in Period 2 (p = 0.002). The transplant rate increased from 168.2 per 100 patient-years in Period 1 to 280.0 per 100 patient-years in Period 2 (incidence rate ratio 2.0, 95% CI 1.2–3.3; p = 0.006). Waitlist mortality rate, hospital stay post-transplantation, and post-transplant mortality did not differ significantly between the time periods. Nineteen patients received HCV NAT+ donor hearts. The short-term post-transplant outcomes were similar between the recipients who received HCV NAT+ and HCV NAT- donor hearts.

CONCLUSIONS

This single-center retrospective analysis suggests that the use of HCV NAT+ donor hearts may result in a reduced HTx waitlist time and an increased transplant rate. In addition, transplanting HCV NAT+ donor hearts into non–HCV-infected recipients, followed by DAAs, can provide acceptable short-term post-transplant outcomes.

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Study design

We analyzed 156 adult patients (aged ≥18 years) who were listed for HTx at the University of California San Diego Cardiovascular Institute between October 27, 2015 and October 26, 2018. All sequential cardiac allograft transplantations including retransplantation (n = 3) and combined organ transplantation (n = 27) were included. Our study population was divided into 2 cohorts based on the time period in which the candidates were initially listed, regardless of when they were ultimately

Comparison of the two listing periods

The demographic characteristics of the candidates listed for HTx, segregated by listing period, are shown in Table 1. Other than a baseline difference in ethnicity, the candidates listed in Period 1 and those in Period 2 had similar characteristics. In Period 1, 57 of the 71 patients (80%) on HTx waitlist were transplanted, whereas in Period 2, 57 of the 85 patients (67%) were transplanted. The candidates listed in Period 1 had a longer waitlist time to transplant (median, 63.1 vs 34.1 days; p

Discussion

To address the growing organ demand and supply mismatch, one strategy is to expand the donor pool by considering higher risk donors for transplantation.13 The availability of highly effective and well-tolerated DAAs for the treatment of HCV infection has provided the opportunity to safely transplant HCV-viremic donor organs into uninfected recipients. Supported by the promising data published by the kidney and liver transplant community,14, 15 our institution implemented the protocol in April

Conclusions

Our single-center retrospective analysis suggests that the use of HCV NAT+ donor hearts may result in a reduced HTx waitlist time and an increase in the transplant rate. In addition, the transplantation of HCV NAT+ donor hearts in non–HCV-infected recipients, followed by DAA therapy, can provide acceptable short-term post-transplant outcomes. However, larger studies with long-term follow-up of patients will be needed to confirm the safety of this approach and also its effect on mortality, both

Disclosure statement

V.P. and E.A. have served on the advisory board and have received speaker fees from Abbott and Medtronic. S.A has been associated with Merck as a consultant. Y.K.G., M.B., and B.H.G. have no conflicts to disclose.

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