The impact of using hepatitis c virus nucleic acid test–positive donor hearts on heart transplant waitlist time and transplant rate
Section snippets
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.
References (19)
- et al.
The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: thirty-fifth adult heart transplantation report-2018; focus theme: multiorgan transplantation
J Heart Lung Transplant
(2018) - et al.
OPTN/SRTR 2017 Annual Data Report: Heart
Am J Transplant
(2019) - et al.
Increasing access to thoracic organs from donors infected with hepatitis C: a previous challenge-now an opportunity
J Heart Lung Transplant
(2018) - et al.
Donor hepatitis-C seropositivity is an independent risk factor for the development of accelerated coronary vasculopathy and predicts outcome after cardiac transplantation
J Heart Lung Transplant
(2004) - et al.
The American Society of Transplantation consensus conference on the use of hepatitis C viremic donors in solid organ transplantation
Am J Transplant
(2017) - et al.
The 2013 International Society for Heart and Lung Transplantation Working Formulation for the standardization of nomenclature in the pathologic diagnosis of antibody-mediated rejection in heart transplantation
J Heart Lung Transplant
(2013) - et al.
International Society for Heart and Lung Transplantation working formulation of a standardized nomenclature for cardiac allograft vasculopathy-2010
J Heart Lung Transplant
(2010) Addressing the growing U.S. donor heart shortage: waiting for Godot or a transplant?
J Am Coll Cardiol
(2017)- et al.
Liver transplantation for hepatitis C virus (HCV) non-viremic recipients with HCV viremic donors
Am J Transplant
(2019)