Brief communicationIncreasing multiorgan heart transplantation with hepatitis C virus donors in the current-era
Section snippets
Study population and definitions
Patient level non-identifiable information was retrieved from United Network for Organ Sharing (UNOS) registry. All adult(≥18-years) multiorgan-HTs between August-2015 and August-2020 where donor HCV antibody (Ab) and NAT status was available were identified. August-2015 was chosen as start date as UNOS mandated routine reporting of donor HCV NAT status during this time.3 Based on donor HCV status, multiorgan-HTs were subdivided into HCV-viremic (HCV NAT positive irrespective of Ab status, HCV
Statistical analysis
Baseline characteristics were compared using Fisher's exact-test for categorical and Kruskal-Wallis test for continuous variables. After meeting study criteria, data was available for all transplants except as indicated. Recipient mortality up to 1-year follow-up post-HT was compared using unadjusted and adjusted Cox-proportional hazards-regression models and Kaplan-Meier (KM) analysis. Cox-models met the proportional hazards assumption as assessed by Schoenfeld's residuals and all recipients
Results
We identified 1322 adult multiorgan-HTs between August-2015 and August-2020 (n = 986 heart-kidney, n = 155 heart-lung, n = 181 heart-liver) where donor HCV Ab/NAT status was available (n = 1,213 HCV-naïve; n = 109 HCV-donor [n = 32 HCV Ab+ nonviremic; n = 77 HCV-viremic], Supplement-Figure-1). The percentage of HCV-donors (HCV Ab+ nonviremic and HCV-viremic) used for multiorgan-HT increased from 0% in 2015 to 14.0% in 2020 (p < 0.001 overall trend, Figure 1A, Supplement-Table-1). Use of both
Variation across UNOS regions and transplant centers
There was a wide variation in use of HCV-donors for multiorgan-HTs across UNOS regions; and regions 11,10,9,5 and 1 together accounted for >80% of multiorgan-HTs performed using HCV-donors (Figure 1B, Supplement-Table-3). Interestingly, there was also a wide discrepancy between the proportion of multiorgan-HTs performed in a UNOS region and the proportion of multiorgan-HTs performed using HCV-donors (Supplement-Figure-3, Supplement-Table-3).
Further, 5 centers accounted for >50% of the total
Post-transplant outcomes
Due to limited number of heart-lung and heart-liver transplants with HCV-donors, we focused on assessing outcomes of the most common multi-organ combination, namely heart-kidney(HK) transplants. Compared to HK-transplants using HCV-naïve donors(n = 896), HK-transplants with HCV-donors (Ab + nonviremic/viremic) (n = 90) had higher recipient creatinine at transplant(3.0[2.1-4.1] vs 2.5[1.8-3.7] mg/dL), more blood-type O(54.4% vs 39.9%), older donors (33[27-40] vs 30[23-39] years), longer
Discussion
We present the first analysis (to the best of our knowledge) of multiorgan-HT using HCV-donors in the contemporary era of DAAs and NAT. Our principal findings are: first, the use of HCV-donors (HCV-viremic and HCV Ab+ nonviremic) for multiorgan-HT has increased significantly in the U.S., paralleling the overall increase in multiorgan-HTs; second, there is a wide variation in the use of HCV-donors for multiorgan-HT across UNOS regions and transplant center volumes, such that it appears only few
Disclosure statement
The authors have no conflicts of interest to declare.
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