Ruck Jessica M, Rodriguez Emily, Zhou Alice L, Durand Christine M, Massie Allan B, Segev Dorry L, Polanco Antonio, Bush Errol L, Kilic Ahmet
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
Division of Infectious Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
J Thorac Cardiovasc Surg. 2025 Mar;169(3):932-940. doi: 10.1016/j.jtcvs.2024.06.025. Epub 2024 Jun 28.
Despite excellent outcomes of heart transplants from hepatitis C virus (HCV)-positive donors (D+), many candidates are not listed to even consider HCV D+ offers.
Using the Scientific Registry of Transplant Recipients, we identified adult (age ≥18 years) heart transplant candidates prevalent on the waitlist between 2018 and March 2023. We compared the likelihood of waitlist mortality or heart transplant by candidate willingness to consider HCV D+ offers using competing risk regression.
We identified 19,415 heart transplant candidates, 68.9% of whom were willing to consider HCV D+ offers. Candidates willing to consider HCV D+ offers had a 37% lower risk of waitlist mortality (subhazard ratio [SHR], 0.63; 95% confidence interval [CI], 0.56-0.70; P < .001) than candidates not willing to consider HCV D+ offers, after adjustment for covariates and center-level clustering. Over the same period, heart transplant candidates willing to consider HCV D+ offers had a 21% higher likelihood of receiving a transplant (SHR, 1.21; 95% CI, 1.7-1.26; P < .001). As a result, among candidates willing to consider HCV D+ offers, 74.9% received a transplant and 6.1% died/deteriorated after 3 years, compared to 68.3% and 9.1%, respectively, of candidates not willing to consider HCV D+ offers. Lower waitlist mortality also was observed on subgroup analyses of candidates on temporary and durable mechanical circulatory support.
Willingness to consider HCV D+ heart offers was associated with a 37% lower risk of waitlist mortality and a 21% higher likelihood of receiving a transplant. We urge providers to encourage candidates to list as being willing to consider offers from donors with hepatitis C to optimize their waitlist outcomes and access to transplantation.
尽管丙型肝炎病毒（HCV）阳性供体（D+）的心脏移植效果良好，但许多候选者甚至未被列入考虑HCV D+供体心脏的名单。
利用移植受者科学注册系统，我们确定了2018年至2023年3月期间在等待名单上的成年（年龄≥18岁）心脏移植候选者。我们使用竞争风险回归比较了候选者考虑HCV D+供体心脏的意愿与等待名单死亡或心脏移植可能性之间的关系。
我们确定了19415名心脏移植候选者，其中68.9%愿意考虑HCV D+供体心脏。在对协变量和中心层面聚类进行调整后，愿意考虑HCV D+供体心脏的候选者等待名单死亡风险比不愿意考虑的候选者低37%（亚风险比[SHR]，0.63；95%置信区间[CI]，0.56 - 0.70；P <.001）。在同一时期，愿意考虑HCV D+供体心脏的心脏移植候选者接受移植的可能性高21%（SHR，1.21；95% CI，1.7 - 1.26；P <.001）。因此，在愿意考虑HCV D+供体心脏的候选者中，74.9%在3年后接受了移植，6.1%死亡/病情恶化，而不愿意考虑HCV D+供体心脏的候选者这两个比例分别为68.3%和9.1%。在对接受临时和持久机械循环支持的候选者进行亚组分析时，也观察到了较低的等待名单死亡率。
考虑HCV D+供体心脏的意愿与等待名单死亡风险降低37%以及接受移植的可能性提高21%相关。我们敦促医疗服务提供者鼓励候选者登记愿意考虑来自丙型肝炎供体的心脏，以优化他们在等待名单上的结果并获得移植机会。
