Trends in the use of hepatitis C viremic donor hearts

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.