TY - JOUR
T1 - Trends in the use of hepatitis C viremic donor hearts
AU - Li, Selena S.
AU - Osho, Asishana
AU - Moonsamy, Philicia
AU - D'Alessandro, David A.
AU - Lewis, Gregory D.
AU - Villavicencio, Mauricio A.
AU - Sundt, Thoralf M.
AU - Funamoto, Masaki
N1 - Publisher Copyright:
© 2020
PY - 2022/5
Y1 - 2022/5
N2 - Objective: To examine trends in utilization of hearts from hepatitis C virus (HCV) viremic donors for transplantation, a strategy to expand organ availability. Methods: The United Network for Organ Sharing (UNOS) registry was queried for adult patients undergoing heart transplantation between 2015 and 2019. We excluded multiorgan transplants, incomplete data, and loss to follow-up. Nucleic acid testing (NAT) defined HCV status. Results: Between 2015 and 2019, a total of 11,393 adults underwent heart transplantation: 326 from HCV NAT+ donors and 11,067 from NAT− donors. The use of NAT+ hearts increased from 1 in 2015 to 137 in 2018 against a static number of NAT− organs. The use of NAT+ hearts varied significantly across regions and individual centers. More than 75% of NAT+ hearts were transplanted in the Northeast region, leading to further travel (mean, 299 miles vs 173 miles for NAT− transplantations; P <.001), with longer ischemic times (mean: 3.52 hours vs 3.10 hours; P <.001). More than one-half of NAT+ transplantations were performed by 5 individual centers, and a single institution accounted for >20% of all transplantations from viremic donors. Survival in the 2 groups did not differ by Kaplan-Meier analysis (P =.240), and multivariable regression showed no differences in acute rejection (P =.455) or 30-day mortality (P =.490). Of the 326 recipients of NAT+ hearts, 38 seroconverted and 14 became viremic within 1 year. Survival was 100% in the viremic patients and 97.4% in seroconverted patients at 1 year. Conclusions: Heart transplantation from HCV viremic donors continues to increase but varies significantly across UNOS regions and individual centers. Short-term outcomes are comparable, but effects of seroconversion and long-term outcomes remain unclear.
AB - Objective: To examine trends in utilization of hearts from hepatitis C virus (HCV) viremic donors for transplantation, a strategy to expand organ availability. Methods: The United Network for Organ Sharing (UNOS) registry was queried for adult patients undergoing heart transplantation between 2015 and 2019. We excluded multiorgan transplants, incomplete data, and loss to follow-up. Nucleic acid testing (NAT) defined HCV status. Results: Between 2015 and 2019, a total of 11,393 adults underwent heart transplantation: 326 from HCV NAT+ donors and 11,067 from NAT− donors. The use of NAT+ hearts increased from 1 in 2015 to 137 in 2018 against a static number of NAT− organs. The use of NAT+ hearts varied significantly across regions and individual centers. More than 75% of NAT+ hearts were transplanted in the Northeast region, leading to further travel (mean, 299 miles vs 173 miles for NAT− transplantations; P <.001), with longer ischemic times (mean: 3.52 hours vs 3.10 hours; P <.001). More than one-half of NAT+ transplantations were performed by 5 individual centers, and a single institution accounted for >20% of all transplantations from viremic donors. Survival in the 2 groups did not differ by Kaplan-Meier analysis (P =.240), and multivariable regression showed no differences in acute rejection (P =.455) or 30-day mortality (P =.490). Of the 326 recipients of NAT+ hearts, 38 seroconverted and 14 became viremic within 1 year. Survival was 100% in the viremic patients and 97.4% in seroconverted patients at 1 year. Conclusions: Heart transplantation from HCV viremic donors continues to increase but varies significantly across UNOS regions and individual centers. Short-term outcomes are comparable, but effects of seroconversion and long-term outcomes remain unclear.
KW - heart transplantation
KW - hepatitis C viremic donor
KW - regional variation
KW - trends in use of donors with hepatitis C
UR - http://www.scopus.com/inward/record.url?scp=85099685217&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2020.09.044
DO - 10.1016/j.jtcvs.2020.09.044
M3 - Article
C2 - 33487431
AN - SCOPUS:85099685217
SN - 0022-5223
VL - 163
SP - 1873-1885.e7
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 5
ER -