This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (7)  • Contact me when this article is cited  Related Content  • Related letters  • Related article  • Similar articles in JAMA  Topic Collections  • Viral Infections  • Cardiovascular Interventions, Other  • Cardiovascular System  • Surgery  • Surgical Interventions  • Cardiovascular/ Cardiothoracic Surgery  • Transplantation  • Cardiac Transplantation  • Transplantation, Other  • Gastroenterology  • Liver/ Biliary Tract/ Pancreatic Diseases  • Cardiovascular Intervention  • Infectious Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Leanne B. Gasink, MD, MSCE; Emily A. Blumberg, MD; A. Russell Localio, PhD; Shashank S. Desai, MD; Ajay K. Israni, MD, MS; Ebbing Lautenbach, MD, MPH

JAMA. 2006;296:1843-1850.

Context  Although liberalization of donor criteria could expand the donor pool, the use of certain "marginal donors," such as those who are hepatitis C virus (HCV) positive, is controversial. Little is known about the effect of donor HCV positivity on survival in cardiac transplantation.

Objectives  To examine the association between donor HCV positivity and survival among heart transplant recipients and to determine the effects of recipient age and recipient HCV status on this association.

Design, Setting, and Participants  A multicenter cohort study was performed using the US Scientific Registry of Transplant Recipients. Adult heart transplant patients who received their transplants between April 1, 1994, and July 31, 2003, were eligible for inclusion.

Main Outcome Measure  All-cause mortality.

Results  Of 10 915 patients meeting entry criteria, 261 received an HCV-positive donor heart. Mortality was higher among recipients of HCV-positive donor hearts at 1 year (16.9% vs 8.2%; P<.001), 5 years (41.8% vs 18.5%; P<.001), and 10 years (50.6% vs 24.3%; P<.001). Using Kaplan-Meier methods, 1-, 5-, and 10-year survival rates were 83%, 53%, and 25%, and 92%, 77%, and 53% for recipients of HCV-positive and HCV-negative donor hearts, respectively (P<.001, log-rank test). Recipients of HCV-positive donor hearts were more likely to die of liver disease and coronary vasculopathy. After propensity matching, the overall hazard ratio (HR) associated with receipt of an HCV-positive donor heart was 2.10 (95% confidence interval [CI], 1.60-2.75). Stratified analyses showed that HRs did not vary by recipient HCV status or by recipient age (for recipients aged 18-39 years: HR, 1.75 [95% CI, 0.70-4.40]; for recipients aged 40-59 years: HR, 2.23 [95% CI, 1.42-3.52]; and for recipients aged 60 years and older: HR, 2.07 [95% CI, 1.32-3.27]; overall P value for interaction, >.10).

Conclusions  Receipt of a heart from an HCV-positive donor is associated with decreased survival in heart transplant recipients. This association appears to be independent of recipient HCV status and age. Preferential allocation of HCV-positive donors to HCV-positive recipients and/or older recipients is not warranted.

Author Affiliations: Division of Infectious Diseases of the Department of Medicine (Drs Gasink, Blumberg, and Lautenbach), Department of Biostatistics and Epidemiology (Drs Localio and Lautenbach), and Center for Clinical Epidemiology and Biostatistics (Drs Gasink, Localio, and Lautenbach), University of Pennsylvania School of Medicine, Philadelphia; Heart Failure and Transplant Program, Inova Fairfax Hospital Department of Medicine, Falls Church, Va (Dr Desai); and Hennepin County Medical Center and Department of Epidemiology and Community Health, University of Minnesota, Minneapolis (Dr Israni).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTERS

Hepatitis C in Organ Donors and Heart Transplant Recipients
and
JAMA. ;297():696-696.
FULL TEXT  

Hepatitis C in Organ Donors and Heart Transplant Recipients--Reply
, , , , , and
JAMA. ;297():696-697.
FULL TEXT  

RELATED ARTICLE

Poorer outcomes for recipients of heart allografts from HCV-positive donors: opening the silos.
and
JAMA. ;296():1900-1901.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The Changing Face of Heart Transplantation
Hunt and Haddad
J Am Coll Cardiol 2008;52:587-598.
ABSTRACT | FULL TEXT  

Predicting survival among high-risk pediatric cardiac transplant recipients: An analysis of the United Network for Organ Sharing database
Davies et al.
J. Thorac. Cardiovasc. Surg. 2008;135:147-155.
ABSTRACT | FULL TEXT  

Hepatitis C in Organ Donors and Heart Transplant Recipients
Taylor and Fontana
JAMA 2007;297:696-696.
FULL TEXT  

HCV-Positive Donor Hearts Associated with Worse Survival
Journal Watch Cardiology 2006;2006:1-1.
FULL TEXT  

Effect of HCV on Survival After Heart Transplantation
JWatch Infect. Diseases 2006;2006:3-3.
FULL TEXT  

What's new in the other general journals
Tonks
BMJ 2006;333:904-905.
FULL TEXT  

Poorer outcomes for recipients of heart allografts from HCV-positive donors: opening the silos.
Qamar and Rubin
JAMA 2006;296:1900-1901.
FULL TEXT