Ruck Jessica M, Zhou Alice L, Zeiser Laura B, Alejo Diane, Durand Christine M, Massie Allan B, Segev Dorry L, Bush Errol L, Kilic Ahmet
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
Division of Infection Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
JTCVS Open. 2022 Nov 3;12:269-279. doi: 10.1016/j.xjon.2022.10.007. eCollection 2022 Dec.
Heart transplants (HTs) from hepatitis C virus (HCV)-viremic donors to HCV-seronegative recipients (HCV D+/R-) have good 6-month outcomes, but practice uptake and long-term outcomes overall and among candidates on mechanical circulatory support (MCS) have yet to be established.
Using the Scientific Registry of Transplant Recipients, we identified US adult HCV-seronegative HT recipients (R-) from 2015 to 2021. We classified donors as HCV-seronegative (D-) or HCV-viremic (D+). We used multivariable regression to compare post-HT extracorporeal membranous oxygenation, dialysis, pacemaker, acute rejection, and risk of post-HT mortality between HCV D+/R- and HCV D-/R-. Models were adjusted for donor, recipient, and transplant characteristics and center HT volume. We performed subgroup analyses of recipients bridged with MCS.
From 2015 to 2021, the number of HCV D+/R- HT increased from 1 to 181 and the number of centers performing HCV D+/R- HT increased from 1 to 60. Compared with HCV D-/R- recipients, HCV D+/R- versus D-/R- recipients overall and among patients bridged with MCS had similar odds of post-HT extracorporeal membranous oxygenation, dialysis, pacemaker, and acute rejection; and mortality risk at 30 days, 1 year, and 3 years (all > .05). High center HT volume but not HCV D+/R- volume (<5 vs >5 in any year) was associated with lower mortality for HCV D+/R- HT.
HCV D+/R- and D-/R- HT have similar outcomes at 3 years' posttransplant. These results underscore the opportunity provided by HCV D+/R- HT, including among the growing population bridged with MCS, and the potential benefit of further expanding use of HCV+ allografts.
将丙型肝炎病毒（HCV）血症供体的心脏移植（HT）给HCV血清学阴性受体（HCV D+/R-），6个月时效果良好，但实际应用情况以及总体和机械循环支持（MCS）候选者中的长期结果尚未明确。
利用移植受者科学登记处的数据，我们确定了2015年至2021年美国成年HCV血清学阴性的心脏移植受者（R-）。我们将供体分类为HCV血清学阴性（D-）或HCV血症（D+）。我们使用多变量回归比较HCV D+/R-和HCV D-/R-之间心脏移植后的体外膜肺氧合、透析、起搏器、急性排斥反应以及心脏移植后死亡风险。模型针对供体、受体、移植特征和中心心脏移植量进行了调整。我们对接受MCS桥接的受者进行了亚组分析。
从2015年到2021年，HCV D+/R-心脏移植的数量从1例增加到181例，进行HCV D+/R-心脏移植的中心数量从1个增加到60个。与HCV D-/R-受者相比，HCV D+/R-与D-/R-受者总体以及接受MCS桥接的患者在心脏移植后的体外膜肺氧合、透析、起搏器和急性排斥反应几率相似；在30天、1年和3年时的死亡风险也相似（均>0.05）。中心心脏移植量高，但HCV D+/R-移植量（任何一年<5例与>5例）与HCV D+/R-心脏移植的较低死亡率无关。
HCV D+/R-和D-/R-心脏移植在移植后3年的结果相似。这些结果强调了HCV D+/R-心脏移植提供的机会，包括在接受MCS桥接的不断增加的人群中，以及进一步扩大使用HCV阳性同种异体移植物的潜在益处。
