Effect of Hepatitis C Virus Infection on Heart Transplants in the Current Era

Transplantation. 2021 Nov 1;105(11):2482-2489. doi: 10.1097/TP.0000000000003638.


Background: The effect of hepatitis C virus (HCV) infection in recipients or donors on heart transplants is less known in the current era after the introduction of direct-acting antiviral agents (DAAs) in 2011.

Methods: Using the United Network for Organ Sharing registry, 24 871 adult heart transplant recipients between 2005 and 2019 were identified. The trend in prevalence of HCV-infected recipients and in utilization of HCV-infected donors and their effect on the transplant outcomes were investigated in the past era versus the current era separated by 2011, using Cox proportional hazard regression.

Results: HCV antibody-positive recipients (n = 520, 2.1%) had stable prevalence (P = 0.18). They had a lower survival estimate when compared with HCV antibody-negative recipients in the past era (55.3% versus 70.9% at 7 y; hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.27-1.91; P < 0.001), however not in the current era (73.1% versus 71.5% at 7 y; HR, 1.00; 95% CI, 0.75-1.32; P = 0.98) (Pinteraction < 0.001). Organ use from HCV antibody-positive donors (n = 371, 1.5%) was concentrated in the recent years (P < 0.001) and provided the similar survival estimate up to 2 y (84.2% versus 87.6%; HR, 0.97; 95% CI, 0.65-1.44; P = 0.87). The similar findings were confirmed with a subgroup cohort with positive nucleic acid amplification test.

Conclusions: Positive HCV antibody in recipients did not adversely affect the long-term transplant outcomes in the current era. Graft utilization from positive HCV antibody or nucleic acid amplification test-positive donors are rapidly more prevalent and appeared to be promising up to 2 y posttransplant.

MeSH terms

  • Adult
  • Antiviral Agents / therapeutic use
  • Graft Survival
  • Heart Transplantation* / adverse effects
  • Hepacivirus / genetics
  • Hepatitis C* / complications
  • Hepatitis C* / diagnosis
  • Hepatitis C* / drug therapy
  • Hepatitis C, Chronic* / drug therapy
  • Humans
  • Tissue Donors


  • Antiviral Agents