Hepatitis C Virus Seropositivity in Organ Donors and Survival in Heart Transplant Recipients
- 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
- 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).
- Corresponding Author: Leanne B. Gasink, MD, MSCE, Division of Infectious Diseases, University of Pennsylvania, 3 Silverstein Pavilion, Suite E, 3400 Spruce St, Philadelphia, PA 19104 (leanne.gasink{at}uphs.upenn.edu).
Abstract
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.
