Paternostro K, Birs A, Aslam S, Adler E, Hong K, Wettersten N
Division of Cardiology, Department of Medicine, University of California San Diego Health, San Diego, CA.
JHLT Open. 2025 Oct 25;11:100416. doi: 10.1016/j.jhlto.2025.100416. eCollection 2026 Feb.
Cardiac allograft vasculopathy (CAV) is a leading cause of death in heart transplant (HTx) recipients. Chronic hepatitis C virus (HCV) infection has been associated with increased inflammation and accelerated CAV. The advent of direct-acting antiviral (DAA) therapy has renewed interest in transplanting HCV-viremic donors, though long-term outcomes remain limited.
We conducted a single-center retrospective study of adult HTx recipients at UC San Diego from 2015 to 2019 who underwent routine intravascular ultrasound (IVUS) surveillance. Recipients were stratified by donor HCV nucleic acid amplification test (NAT) status. Donor-derived HCV infection was treated with DAA therapy. We used multivariable-adjusted Cox regression to evaluate the primary endpoint of developing CAV, defined as maximal intimal thickness (MIT) ≥ 0.5 mm, and endpoints of MIT ≥ 0.7 mm and a composite outcome of incident acute coronary syndrome, percutaneous coronary intervention (PCI), and all-cause mortality.
Among 131 recipients, 22 received HCV NAT+ hearts. Baseline donor and recipient characteristics were similar, except for recipients of HCV NAT- hearts were younger (53.7 years vs 61.0 years; = 0.022). Over a median follow-up of 6.6 years, HCV NAT+ status was not associated with a higher risk of CAV (MIT ≥ 0.5 mm: adjusted HR 0.89, 95% confidence interval (CI), 0.52-1.53; = 0.673; MIT ≥ 0.7 mm: adjusted HR 0.91, 95% CI 0.51-1.61; = 0.750), nor the composite outcome (adjusted HR 1.23, 95% CI, 0.45-3.40; = 0.690).
In the modern DAA era, transplantation of HCV NAT+ donor hearts is not associated with increased risk of CAV or adverse clinical outcomes over intermediate-term follow-up.
心脏移植血管病变（CAV）是心脏移植（HTx）受者死亡的主要原因。慢性丙型肝炎病毒（HCV）感染与炎症增加和CAV加速发展有关。直接作用抗病毒（DAA）疗法的出现重新引发了对移植HCV病毒血症供体的兴趣，尽管长期结果仍然有限。
我们对2015年至2019年在加州大学圣地亚哥分校接受常规血管内超声（IVUS）监测的成年HTx受者进行了一项单中心回顾性研究。受者根据供体HCV核酸扩增试验（NAT）状态进行分层。供体来源的HCV感染采用DAA疗法治疗。我们使用多变量调整的Cox回归来评估发生CAV的主要终点，定义为最大内膜厚度（MIT）≥0.5mm，以及MIT≥0.7mm的终点和急性冠状动脉综合征、经皮冠状动脉介入治疗（PCI）和全因死亡率的复合结局。
在131名受者中，22名接受了HCV NAT阳性的心脏。除了HCV NAT阴性心脏的受者更年轻（53.7岁对61.0岁；P = 0.022）外，基线供体和受者特征相似。在中位随访6.6年期间，HCV NAT阳性状态与CAV风险较高无关（MIT≥0.5mm：调整后HR 0.89，95%置信区间（CI），0.52 - 1.53；P = 0.673；MIT≥0.7mm：调整后HR 0.91，95%CI 0.51 - 1.61；P = 0.750），也与复合结局无关（调整后HR 1.23，95%CI，0.45 - 3.40；P = 0.690）。
在现代DAA时代，中期随访中，移植HCV NAT阳性供体心脏与CAV风险增加或不良临床结局无关。
