Hong Yeahwa, Couper Caitlin D, Iyanna Nidhi, Hess Nicholas R, Ziegler Luke A, Abdullah Mohamed, Mathier Michael A, Hickey Gavin W, Keebler Mary E, Silvestry Scott C, Kaczorowski David
Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Transplantation. 2025 Apr 1;109(4):701-714. doi: 10.1097/TP.0000000000005193. Epub 2024 Sep 4.
This study evaluates the clinical trends and impact of hepatitis C virus-positive (HCV+) donors on waitlist and posttransplant outcomes after heart transplantation.
The United Network for Organ Sharing registry was queried to identify adult waitlisted and transplanted patients from January 1, 2015, to December 31, 2022. In the waitlist analysis, the candidates were stratified into 2 cohorts based on whether they were willing to accept HCV+ donor offers. Waitlist outcomes included 1-y cumulative incidences of transplantation and death/delisting. In the posttransplant analysis, the recipients were stratified into 2 cohorts with and without HCV nucleic acid test (NAT)-positive donors. Outcomes included 1- and 4-y posttransplant survival. Propensity score-matching was performed. Risk adjustment was performed using multivariable Cox regression.
During the study period, the number of centers using HCV NAT+ donors increased from 1 to 65 centers, along with the number of transplants. In the waitlist analysis, 26 648 waitlisted candidates were analyzed, and 4535 candidates (17%) were approved to accept HCV+ donors. Approval to accept HCV+ donors was associated with a higher likelihood of transplantation and a lower likelihood of death/delisting within 1 y of waitlisting. In the posttransplant analysis, 21 131 recipients were analyzed, and 997 recipients (4.7%) received HCV NAT+ hearts. The 1- and 4-y posttransplant survival were comparable between the recipients of HCV NAT+ and NAT- donors. Furthermore, the similar 1- and 4-y posttransplant survival persisted in the propensity score-matched comparison and multivariable Cox regression analysis.
Utilization of HCV+ donors is rising. Heart transplants using HCV+ donors are associated with improved waitlist and comparable posttransplant outcomes.
本研究评估丙型肝炎病毒阳性（HCV+）供体对心脏移植等待名单及移植后结果的临床趋势和影响。
查询器官共享联合网络登记处，以确定2015年1月1日至2022年12月31日期间成年等待名单上的患者和已移植患者。在等待名单分析中，根据候选人是否愿意接受HCV+供体提供的心脏，将其分为两个队列。等待名单结果包括移植的1年累积发生率以及死亡/退出名单。在移植后分析中，将接受者分为有和没有HCV核酸检测（NAT）阳性供体的两个队列。结果包括移植后1年和4年的生存率。进行倾向得分匹配。使用多变量Cox回归进行风险调整。
在研究期间，使用HCV NAT+供体的中心数量从1个增加到65个，移植数量也随之增加。在等待名单分析中，对26648名等待名单上的候选人进行了分析，其中4535名候选人（17%）被批准接受HCV+供体。批准接受HCV+供体与移植可能性较高以及等待名单1年内死亡/退出名单可能性较低相关。在移植后分析中，对21131名接受者进行了分析，其中997名接受者（4.7%）接受了HCV NAT+心脏。HCV NAT+供体和NAT-供体的接受者移植后1年和4年生存率相当。此外，在倾向得分匹配比较和多变量Cox回归分析中，移植后1年和4年生存率相似的情况依然存在。
HCV+供体的使用正在增加。使用HCV+供体进行心脏移植与等待名单情况改善以及移植后结果相当相关。
