Utilization Rates and Clinical Outcomes of Hepatitis C Positive Donor Hearts in The Contemporary Era

Abstract Background Hepatitis C virus(HCV) donors should be categorized as HCV-viremic [Antibody(Ab) –or+/Nucleic Acid testing(NAT)+] or HCV Ab+ nonviremic (Ab+/NAT-). Whereas recipients of hearts from HCV-viremic donors will develop viremia but can likely be cured of HCV shortly after transplant with direct-acting antivirals (DAAs), recipients of hearts from HCV Ab+ nonviremic donors are highly unlikely to become viremic or require DAAs. Given this important difference in risk, we assessed the utilization trends and post heart-transplantation(HT) outcomes of HCV-naive (Ab-/NAT-), HCV-viremic and HCV Ab+ nonviremic donor hearts. Methods 26,572 adult donors(≥18 years) with information on HCV Ab and NAT status were identified in United Network for Organ Sharing registry between August-2015 and June-2018 for utilization rates. Adult HT recipients of these donors were compared for primary graft failure(PGF) at 90 days and 1-year recipient survival. Results 96 HCV Ab+ nonviremic and 135 HCV-viremic adult donor hearts were transplanted during the study period. The utilization rates of both HCV Ab+ nonviremic (1.4% to 23.4%) and HCV-viremic (0.7% to 25.4%) donor hearts increased significantly approaching HCV-naive rates (29.04%). There was no significant difference in rates of PGF and 1-year survival between recipients in the three donor HCV groups. We also used (1:3) propensity score matching and found similar 1-year survival in different donor HCV groups ( HCV-naive vs. HCV Ab+ nonviremic, p=0.59 and HCV-naive vs. HCV-viremic , p=0.98). Conclusions Recipients of HCV-viremic and HCV Ab+ nonviremic donor hearts had equivalent risk of PGF and 1-year mortality compared to recipients of HCV-naive donor hearts. While only HCV-viremic organs require DAAs, and although the risk of coronary artery vasculopathy after treated HCV infection has not been defined, the utilization rates of both HCV Ab+ nonviremic and HCV-viremic adult donor hearts have increased at an equal pace now approaching HCV-naive rates.