The impact of using hepatitis c virus nucleic acid test-positive donor hearts on heart transplant waitlist time and transplant rate

Yan K Gernhofer; Michela Brambatti; Barry H Greenberg; Eric Adler; Saima Aslam; Victor Pretorius

doi:10.1016/j.healun.2019.08.010

The impact of using hepatitis c virus nucleic acid test-positive donor hearts on heart transplant waitlist time and transplant rate

J Heart Lung Transplant. 2019 Nov;38(11):1178-1188. doi: 10.1016/j.healun.2019.08.010. Epub 2019 Aug 14.

Authors

Yan K Gernhofer¹, Michela Brambatti², Barry H Greenberg², Eric Adler², Saima Aslam³, Victor Pretorius⁴

Affiliations

¹ Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of California, San Diego, La Jolla, California. Electronic address: yako@ucsd.edu.
² Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, California.
³ Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California.
⁴ Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of California, San Diego, La Jolla, California.

PMID: 31492607
DOI: 10.1016/j.healun.2019.08.010

Abstract

Background: Previous studies suggest that direct-acting anti-virals (DAAs) for the treatment of hepatitis C virus (HCV) infection permits the transplantation of HCV-viremic donor organs in uninfected recipients. This opportunity may expand the donor pool. We assessed the impact of using HCV nucleic acid test-positive (NAT+) donor hearts on heart transplant (HTx) waitlist time and transplant rate.

Methods: We retrospectively analyzed 156 patients who were listed for HTx from October 2015 through October 2018. Patients were stratified into 2 periods centered on April 27, 2017, when the protocol to accept HCV NAT+ donor organs for transplantation in non-HCV-infected recipients began, Period 1 (October 27, 2015 to April 26, 2017) and Period 2 (April 27, 2017 to October 26, 2018).

Results: In Period 1, 57 of the 71 patients on the HTx waitlist were transplanted, whereas in Period 2, 57 of the 85 patients were transplanted. The median waitlist time to transplant decreased from 63.1 days in Period 1 to 34.1 days in Period 2 (p = 0.002). The transplant rate increased from 168.2 per 100 patient-years in Period 1 to 280.0 per 100 patient-years in Period 2 (incidence rate ratio 2.0, 95% CI 1.2-3.3; p = 0.006). Waitlist mortality rate, hospital stay post-transplantation, and post-transplant mortality did not differ significantly between the time periods. Nineteen patients received HCV NAT+ donor hearts. The short-term post-transplant outcomes were similar between the recipients who received HCV NAT+ and HCV NAT- donor hearts.

Conclusions: This single-center retrospective analysis suggests that the use of HCV NAT+ donor hearts may result in a reduced HTx waitlist time and an increased transplant rate. In addition, transplanting HCV NAT+ donor hearts into non-HCV-infected recipients, followed by DAAs, can provide acceptable short-term post-transplant outcomes.

Keywords: direct-acting anti-virals; heart transplantation; hepatitis C virus; transplant rate; waitlist time.

Publication types

Comparative Study

MeSH terms

Aged
Clinical Laboratory Techniques
Donor Selection / methods*
Female
Heart Transplantation / statistics & numerical data*
Hepacivirus / genetics*
Hepatitis C / virology
Humans
Male
Middle Aged
RNA, Viral / analysis*
Retrospective Studies
Time Factors
Waiting Lists* / mortality

Substances

RNA, Viral