Heart-Kidney Transplantation and Hepatitis C Virus Positive Donors

Purpose Novel hepatitis C virus (HCV) therapies have expanded the donor pool for heart transplantation (HT). However, multi-center data for heart-kidney transplant (HKT) recipients of HCV(+) donors is not yet available. Methods We analyzed adults undergoing first-time HKT between October 16th, 2014 & December 31st, 2019 using United Network for Organ Sharing (UNOS) registry; follow-up was available through March 4th 2021. Data on recipient & donor characteristics were compared by donor's HCV status (defined as presence of either positive HCV antibody (Ab) or Nucleic Acid Test (NAT); Kaplan-Meier survival & Cox-proportional hazard estimates were computed. We also conducted a propensity score matching (PSM) analysis by matching HCV(+) donors with non-HCV donors. A separate sub-group analysis stratified by donor's HCV-Ab & NAT status was also performed. Results A total of 785 recipients (n=60 HCV(+) and n=725 non-HCV donors) were identified (age: 59 years (interquartile range (IQR): 51, 64), 82.4% males, 34.4% blacks). Recipients of HCV(+) donors were more likely to be from UNOS regions 1, 5, 10 or 11 & were transplanted at high-volume centers (p<0.05). HCV(+) donors were more likely to be older, Caucasians, smoker, dying of drug-overdose & with lower body-mass index (p<0.05). Distance between recipient & donor centers was significantly greater, resulting in longer ischemic times, & predicted heart-mass ratio was significantly lower among recipients with HCV(+) donors (p<0.05). Despite of these unfavorable factors, 1-year survival was similar between HCV(+) & non-HCV donors; similar trends were observed upon PSM analysis & sub-group analysis (FIGURE). Post-HKT length of stay (25 days (IQR: 14, 52) Vs 22 days (IQR: 15, 34), p=0.256) & index-hospital need for dialysis (32% Vs 33%, p=0.784) did not differ between recipients of HCV(+) and non-HCV donors, respectively. Conclusion Given excellent 1-year survival and short-term outcomes, HCV(+) donors offer an opportunity to expand the donor pool for recipients in need of HKT. Novel hepatitis C virus (HCV) therapies have expanded the donor pool for heart transplantation (HT). However, multi-center data for heart-kidney transplant (HKT) recipients of HCV(+) donors is not yet available. We analyzed adults undergoing first-time HKT between October 16th, 2014 & December 31st, 2019 using United Network for Organ Sharing (UNOS) registry; follow-up was available through March 4th 2021. Data on recipient & donor characteristics were compared by donor's HCV status (defined as presence of either positive HCV antibody (Ab) or Nucleic Acid Test (NAT); Kaplan-Meier survival & Cox-proportional hazard estimates were computed. We also conducted a propensity score matching (PSM) analysis by matching HCV(+) donors with non-HCV donors. A separate sub-group analysis stratified by donor's HCV-Ab & NAT status was also performed. A total of 785 recipients (n=60 HCV(+) and n=725 non-HCV donors) were identified (age: 59 years (interquartile range (IQR): 51, 64), 82.4% males, 34.4% blacks). Recipients of HCV(+) donors were more likely to be from UNOS regions 1, 5, 10 or 11 & were transplanted at high-volume centers (p<0.05). HCV(+) donors were more likely to be older, Caucasians, smoker, dying of drug-overdose & with lower body-mass index (p<0.05). Distance between recipient & donor centers was significantly greater, resulting in longer ischemic times, & predicted heart-mass ratio was significantly lower among recipients with HCV(+) donors (p<0.05). Despite of these unfavorable factors, 1-year survival was similar between HCV(+) & non-HCV donors; similar trends were observed upon PSM analysis & sub-group analysis (FIGURE). Post-HKT length of stay (25 days (IQR: 14, 52) Vs 22 days (IQR: 15, 34), p=0.256) & index-hospital need for dialysis (32% Vs 33%, p=0.784) did not differ between recipients of HCV(+) and non-HCV donors, respectively. Given excellent 1-year survival and short-term outcomes, HCV(+) donors offer an opportunity to expand the donor pool for recipients in need of HKT.