411 Hepatitis C Donor Hearts in Noninduction Immunosuppressive Regimens Portend Poor Outcome After Heart Transplantation.

Abstract

BackgroundOutcome of patients transplanted with hepatitis C (hep-C) donor hearts has been reported to be poor. Induction therapy may confer increased risk to these patients. The outcome of hep-C in a noninduction cardiac transplant (CTx) population has not been established.MethodsWe reviewed 455 patients between 1/1994 and 3/2002. We found 18 patients who received hep-C donor hearts. 8 patients were status IA, and 10 were on our alternate CTx waiting list, which justified the use of these donor organs at that time. 5 of these patients were also hep-C positive prior to transplant (after undergoing liver biopsy demonstrating only mild disease). All patients were treated with cyclosporine/tacrolimus, and 12 also received azathioprine (AZA) while 6 received mycophenolate mofetil (MMF) without cytolytic induction therapy.ResultsThe 18 patients who received a hep-C-positive donor heart had significantly lower 1- and 5-year survival compared to CTx patients without hep-C (1-year survival 77.8% vs 81.2%, p = .028; 5-year survival 38.9% vs 71.9%, p = .007). The development of rejection and cardiac allograft vasculopathy (CAV) were not significantly increased compared to the control group. The 5 patients who were hep-C positive at the time of transplant had similar poor outcomes (5-year survival 20%). However, 4 of these 5 hep-C-positive recipients developed CAV compared to 1/13 hep-C-negative recipients. All patients were divided into those patients receiving AZA vs MMF immunosuppression, but there was no significant difference in outcomes between the use of these medications.ConclusionDonor or recipient hep-C is associated with poor outcome in CTx patients with noninduction immunosuppressive regimens. Donor hearts with hep-C should not be used. In addition, hep-C-positive recipients appear to be at higher risk for the development of CAV.