Heart transplants from hepatitis C-positive donors could ease organ shortages
Hepatitis C-positive donors could be safely used for heart transplants, as a large study finds similar survival, rejection and complication rates between patients who received transplants from hepatitis C-positive and hepatitis C-negative donors.
A large, multicenter study, published in the Journal of the American Heart Association, has observed similar outcomes between patients receiving heart transplants from hepatitis C-positive and -negative donors 1 year after transplantation. Researchers from the University of Pittsburgh Medical Center (PA, USA) evaluated the 1-year survival rates of 7889 adults who received isolated heart transplants from 2016–2018 in the USA.
Patients with severe heart failure often need a heart transplant in order to survive, however there is a persistent shortage of donors compared with the number of patients awaiting transplants. Finding safe donor populations will help to ease this shortage.
Hepatitis C-positive organ donors have historically been avoided due to perceived increased risk of liver disease and coronary allograft vasculopathy, likely related to the use of interferon-based therapy for hepatitis C. With the introduction of direct-acting antiviral drugs to treat hepatitis C, hepatitis-C positive donors have re-emerged as a viable addition to organ supplies.
Of the 7889 patients included in this study, across 128 centers, 343 received transplants from hepatitis C-positive donors. Researchers observed no statistical differences in overall 1-year survival rates of patients receiving hepatitis C-positive and -negative donor transplants, nor were there significant differences between rates of drug-treated rejection, postoperative stroke and new-onset postoperative dialysis.
While promising, the study followed patients for only 1 year after receiving a transplant; longer-term outcomes should be considered to corroborate the findings beyond this timeframe. Furthermore, the population of patients receiving transplants from hepatitis C-positive donors was relatively small. These results will hopefully increase the proportion of centers willing to use hepatitis C-positive donors, thus widening sample populations to be considered in further studies of transplants from hepatitis C-positive donors.
Rates of heart failure in developed countries remain high, and the researchers noted the importance of adapting protocols related to hepatitis C-positive donors in order to reduce the shortage of organs available for transplantation.
Lead study author Arman Kilic (University of Pittsburgh Medical Center) noted the importance of the study for transplant availability: "We are encouraged by these results and believe this is a landmark change in our ability to better meet the demand for heart transplantation by increasing the donor supply. It is our hope that more centers will use hepatitis C-positive donors for heart transplantation."
Kilic A, Hickey G, Mathier M et al. Outcomes of adult heart transplantation using hepatitis C-positive donors. J. Am. Heart Assoc. doi:10.1161/JAHA.119.014495 (2020); (Epub ahead of print);