The summaries are free for public
use. The Chronic Liver Disease
Foundation will continue to add and
archive summaries of articles deemed
relevant to CLDF by the Board of
Trustees and its Advisors.
Abstract Details
Early Outcomes of Multivisceral Transplant using Hepatitis C Positive Donors
Ann Thorac Surg. 2020 Oct 26;S0003-4975(20)31736-7. doi: 10.1016/j.athoracsur.2020.08.044.Online ahead of print.
William G McMaster Jr1, Zakiur M Rahaman2, Maren E Shipe3, Eric N Quintana4, Emily M Sandhaus5, Sarah S Smith6, Jerod E Crockett7, Rachel C Forbes8, Kelly H Schlendorf9, Ashish S Shah10
Author information
1Assistant Professor, Department of Cardiac Surgery, Vanderbilt University Medical Center, 1211 Medical Center Dr., Nashville, TN 37212. Electronic address: william.g.mcmaster@vumc.org.
2Research Fellow, Department of Cardiac Surgery, Vanderbilt University Medical Center, 1211 Medical Center Dr., Nashville, TN 37212.
3General Surgery Resident, Research Fellow, Division of General Surgery, Vanderbilt University Medical Center, 1211 Medical Center Dr., Nashville, TN 37212.
4Thoracic Resident, Division of Thoracic Surgery, Vanderbilt University Medical Center, 1211 Medical Center Dr., Nashville, TN 37212.
5Registered Nurse, Heart Transplant Waitlist Manager, Vanderbilt University Medical Center, 1211 Medical Center Dr., Nashville, TN 37212.
6Heart Transplant Coordinator, Vanderbilt Heart Transplant Program, Vanderbilt University Medical Center, 1211 Medical Center Dr., Nashville, TN 37212.
7Research Assistant, Department of Thoracic Surgery, Vanderbilt University Medical Center, 1211 Medical Center Dr., Nashville, TN 37212.
8Associate Professor of Surgery, Division of Kidney and Pancreas Transplantation, Vanderbilt University Medical Center, 1211 Medical Center Dr., Nashville, TN 37212.
9Assistant Professor of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, 1211 Medical Center Dr., Nashville, TN 37212.
10Professor of Surgery, Department of Cardiac Surgery, Vanderbilt University Medical Center, 1211 Medical Center Dr., Nashville, TN 37212.
Abstract
Background: In the era of direct-acting antiviral therapies, hepatitis C positive organs offer a strategy to expand the donor pool. Heart failure patients with concomitant renal insufficiency benefit from combined heart/kidney transplant. In 2017, we began utilizing organs from hepatitis C donors for heart/kidney transplants.
Methods: Characteristics and outcomes of heart/kidney transplants were collected at our institution from 2012 through 2019. We determined patient cohorts by donor hepatitis C antibody status, antibody positive (HCV+) versus antibody negative (HCV-). Outcomes of interest include survival, postoperative allograft function, and waitlist time. Summary and descriptive statistics, as well as survival analyses, were performed.
Results: Thirty-nine patients underwent heart/kidney transplantation from 2012-2019. Twelve patients received HCV+ organs, while 27 patients received HCV- organs with minimal differences in donor and recipient cohort characteristics. Recipients who consented to receive HCV+ organs had a shorter median waitlist time. HCV+ and HCV- groups had similar perioperative and early postoperative cardiac function and similar rates of delayed renal graft function. HCV+ recipients demonstrated higher creatinine levels at 3-months post-transplant compared to HCV- recipients, but by 1-year post-transplant, creatinine levels in both groups were similar. The groups had similar 30-day and 1-year survival.
Conclusions: This study is the first and largest single-center series of combined heart/kidney transplants using HCV+ donors. When the potential increased risk of early postoperative renal dysfunction is balanced against similar survival and decreased waitlist time, the results suggest that HCV+ donors are an important source of transplantable organs for heart-kidney transplantation.