Kwon Jennie H, Hill Morgan A, Patel Raj, Tedford Ryan J, Hashmi Zubair A, Shorbaji Khaled, Huckaby Lauren V, Welch Brett A, Kilic Arman
Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina.
Department of Cardiology, Medical University of South Carolina, Charleston, South Carolina.
Ann Thorac Surg. 2023 Feb;115(2):493-500. doi: 10.1016/j.athoracsur.2022.11.002. Epub 2022 Nov 9.
Advances in hepatitis C virus (HCV) treatment and the ongoing opioid epidemic have made HCV-positive donors increasingly available for heart transplantation (HT). This analysis reports outcomes of over 1000 HCV-positive HTs in the United States in the modern era.
The United Network of Organ Sharing registry was used to identify HTs between 2015 and 2021. Recipients were grouped by donor HCV status and by nucleic acid amplification test (NAT) positivity. The primary outcome was 1-year mortality, and secondary outcomes included 3-year mortality. A subanalysis compared HCV-positive HT outcomes between NAT-positive and NAT-negative donors. Risk adjustment was performed using Cox regression. Kaplan-Meier analysis was used to estimate survival.
The frequency of HCV-positive HT increased from 0.12% of HTs in 2015 to 12.9% in 2021 (P < .001). Of 16,648 HTs, 1170 (7.0%) used an organ from an HCV-positive donor. Recipients of HCV-positive organs were more likely to be HCV seropositive, older, and White. Unadjusted 1- and 3-year survival rates were not significantly different between recipients of HCV-negative and HCV-positive organs. After risk adjustment HCV-positive donor status was not associated with an elevated risk for 1-year (hazard ratio, 0.92; 95% CI, 0.71-1.19; P = .518) or 3-year mortality. Among HCV-positive HTs 772 (61.7%) were NAT positive. After risk adjustment NAT positivity did not impact 1-year mortality.
The proportion of HCV-positive HTs has increased over 100-fold in recent years. This analysis of the US experience demonstrates that recipients of HCV-positive hearts, including those that are NAT positive, have acceptable outcomes with similar early to midterm survival as recipients of HCV-negative organs.
丙型肝炎病毒（HCV）治疗的进展以及持续的阿片类药物流行使得HCV阳性供体越来越多地可用于心脏移植（HT）。本分析报告了现代美国1000多例HCV阳性心脏移植的结果。
利用器官共享联合网络登记处来识别2015年至2021年期间的心脏移植。接受者按供体HCV状态和核酸扩增试验（NAT）阳性情况进行分组。主要结局为1年死亡率，次要结局包括3年死亡率。一项亚分析比较了NAT阳性和NAT阴性供体的HCV阳性心脏移植结果。使用Cox回归进行风险调整。采用Kaplan-Meier分析来估计生存率。
HCV阳性心脏移植的频率从2015年心脏移植的0.12%增至2021年的12.9%（P <.001）。在16648例心脏移植中，1170例（7.0%）使用了来自HCV阳性供体的器官。HCV阳性器官的接受者更可能HCV血清学阳性、年龄较大且为白人。HCV阴性和HCV阳性器官接受者的未调整1年和3年生存率无显著差异。经过风险调整后，HCV阳性供体状态与1年（风险比，0.92；95%CI，0.71 - 1.19；P = 0.518）或3年死亡率升高无关。在HCV阳性心脏移植中，772例（6
