Using hepatitis C and B virus-infected donor organs for pediatric heart transplantation

Objective: High-risk donors for patients with end-stage cardiac or pulmonary disease awaiting transplantation represent an opportunity for access to more organs and therefore can significantly decrease the waiting list mortality. The objective of this study is to investigate the use of hepatitis B virus core antibody positive or hepatitis C virus seropositive donors for pediatric heart transplantation.

Methods: Data were reviewed from the United Network of Organ Sharing database (June 2008 to June 2015). A total of 3 hepatitis C seropositive and 9 hepatitis B core antibody positive donor hearts were identified for transplantation. Factors of age, underlying diagnosis, transplant year, extracorporeal membrane oxygenation, inotrope support, hepatitis C virus serostatus, and hepatitis B virus surface antigen status were used for 2 separate propensity score models. Standardized difference was evaluated for these variables before and after match. Survival was compared between the matched cohorts.

Results: Post-transplant graft survivals for recipients of hepatitis C virus positive donors and hepatitis B virus core antibody positive donors were similar to matched recipients of hepatitis C virus negative and hepatitis B virus core antibody negative donors, respectively.

Conclusions: The study has a small cohort to derive any significant conclusions, but the results are encouraging and consistent with the current trends among adult thoracic and pediatric kidney transplantation and demonstrates that hepatitis C virus positive and hepatitis B virus core antibody positive donors are not often used for pediatric heart transplantation.