Li Selena S, Osho Asishana, Moonsamy Philicia, D'Alessandro David A, Lewis Gregory D, Villavicencio Mauricio A, Sundt Thoralf M, Funamoto Masaki
Department of Surgery, Massachusetts General Hospital, Boston, Mass.
Department of Surgery, Massachusetts General Hospital, Boston, Mass; Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass.
J Thorac Cardiovasc Surg. 2022 May;163(5):1873-1885.e7. doi: 10.1016/j.jtcvs.2020.09.044. Epub 2020 Sep 16.
To examine trends in utilization of hearts from hepatitis C virus (HCV) viremic donors for transplantation, a strategy to expand organ availability.
The United Network for Organ Sharing (UNOS) registry was queried for adult patients undergoing heart transplantation between 2015 and 2019. We excluded multiorgan transplants, incomplete data, and loss to follow-up. Nucleic acid testing (NAT) defined HCV status.
Between 2015 and 2019, a total of 11,393 adults underwent heart transplantation: 326 from HCV NAT donors and 11,067 from NAT donors. The use of NAT hearts increased from 1 in 2015 to 137 in 2018 against a static number of NAT organs. The use of NAT hearts varied significantly across regions and individual centers. More than 75% of NAT hearts were transplanted in the Northeast region, leading to further travel (mean, 299 miles vs 173 miles for NAT transplantations; P < .001), with longer ischemic times (mean: 3.52 hours vs 3.10 hours; P < .001). More than one-half of NAT transplantations were performed by 5 individual centers, and a single institution accounted for >20% of all transplantations from viremic donors. Survival in the 2 groups did not differ by Kaplan-Meier analysis (P = .240), and multivariable regression showed no differences in acute rejection (P = .455) or 30-day mortality (P = .490). Of the 326 recipients of NAT hearts, 38 seroconverted and 14 became viremic within 1 year. Survival was 100% in the viremic patients and 97.4% in seroconverted patients at 1 year.
Heart transplantation from HCV viremic donors continues to increase but varies significantly across UNOS regions and individual centers. Short-term outcomes are comparable, but effects of seroconversion and long-term outcomes remain unclear.
研究将丙型肝炎病毒（HCV）病毒血症供体的心脏用于移植的趋势，这是一种扩大器官供应的策略。
查询器官共享联合网络（UNOS）登记处2015年至2019年间接受心脏移植的成年患者信息。我们排除了多器官移植、数据不完整以及失访情况。核酸检测（NAT）确定HCV状态。
2015年至2019年间，共有11393名成年人接受了心脏移植：326例来自HCV NAT供体，11067例来自NAT供体。在NAT器官数量不变的情况下，NAT心脏的使用量从2015年的1例增加到2018年的137例。NAT心脏的使用在不同地区和各个中心差异显著。超过75%的NAT心脏在东北地区进行移植，这导致了更远的运输距离（平均299英里，而NAT移植为173英里；P <.001），且缺血时间更长（平均：3.52小时对3.10小时；P <.001）。超过一半的NAT移植由5个独立中心进行，单个机构占病毒血症供体所有移植的20%以上。通过Kaplan-Meier分析，两组的生存率无差异（P =.240），多变量回归显示急性排斥反应（P =.455）或30天死亡率（P =.490）无差异。在326例NAT心脏受者中，38例在1年内血清转化，14例出现病毒血症。病毒血症患者1年生存率为100%，血清转化患者为97.4%。
来自HCV病毒血症供体的心脏移植持续增加，但在UNOS各地区和各个中心差异显著。短期结果具有可比性，但血清转化的影响和长期结果仍不清楚。
