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Abstract Details
Increasing multiorgan heart transplantation with hepatitis C virus donors in the current-era
J Heart Lung Transplant. 2021 May 29;S1053-2498(21)02328-7.doi: 10.1016/j.healun.2021.05.018. Online ahead of print.
Shivank Madan1, Snehal R Patel2, Peter Vlismas2, Vagish Hemmige3, Omar Saeed2, Daniel J Goldstein4, Ulrich P Jorde2
Author information
1Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York. Electronic address: smadan@montefiore.org.
2Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
3Division of Infectious Diseases, Department of Internal Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
4Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
Abstract
The trends and outcomes of multiorgan heart-transplantation (HT) using hepatitis C virus (HCV) donors in the contemporary era are sparsely known. Using UNOS registry, 1322 adult multiorgan-HTs (n = 986 heart-kidney, n = 155 heart-lung, n = 181 heart-liver) between August-2015 and August-2020 were identified, of which 109 were performed using HCV-donors (n = 77 HCV nucleic-acid-amplification testing [NAT] positive irrespective of antibody status [HCV-viremic]; and n = 32 HCV Ab+/NAT-[HCV antibody + nonviremic]). The percentage of HCV-donors used for multiorgan-HT increased from 0% in 2015 to 14% in 2020 (p < 0.001), but there was wide variation across UNOS regions and center volumes. Recipients of multiorgan heart-kidney transplants from HCV-donors (n = 90) and HCV-naïve (HCV Ab-/NAT-) donors (n = 896) had similar 1-year survival using unadjusted and adjusted Cox-proportional hazards-regression models including in propensity-score matched cohorts. Post-HT rates of cardiac-allograft-vasculopathy (5.4% vs 5.8%) and chronic-dialysis (7.3% vs 4.9%) at 1-year were also similar. Use of HCV-donors (HCV-viremic, HCV Ab+ nonviremic) for multiorgan-HT has increased significantly. Encouraging 1-year outcomes in heart-kidney recipients from HCV-donors should support further expansion of heart-kidney transplantation using HCV-donors.