Local and regional variability in utilization and allocation of hepatitis C virus–infected hearts for transplantation

Abstract

The number of heart transplants (HT) has been rising in the United States each year, with a record 3551 transplants performed in 2019. 1 Despite this, more than 3709 people continue to await HT, with waitlist times averaging months to years. Each year, 5%-10% of HT candidates die on the waitlist. 1 There has been an increase in the rate of hepatitis C virus-infected (HCV+) organs available for transplant. 2-4 Drug overdose deaths (ODD) are a large contributor, with the CDC reporting approximately 70 000 ODDs in 2017, of which 30% were estimated to be HCV+ donors. 3,5 ODD donors are usually younger, have less comorbid conditions, and are more likely to have died from anoxia, 3 factors associated with improved posttransplant survival. 6,7 Historically

Current status and outcomes in heart transplantation: a narrative review

“…The frequency of HCV+ donors in HTx increased from 0.6% in 2016 to 11.45% in 2019 [65]. This was accompanied by an increase in utilization rate of hearts from non-viremic HCV+ donors (27.6%) and viremic HCV+ donors (30.9%), both of which are now equivalent to utilization of HCV-donors (31.7%) in 2019 [66]. Concurrently, the willingness of HTx candidates to accept allografts from HCV+ donors increased from <20% before 2016 to almost 40% in 2018 [63], and the number of transplant centers utilizing HCV+ donor hearts increased from 8.5% to 29.4% [67].…”

Hepatitis C and heart transplantation: An update

“…Thus, a marked increase in heart transplant programs that use of HCV NAT-positive donors has been seen in the United States since 2017, although with significant regional and center-specific variations. [47][48][49] Transplantation of hearts from HCV-viremic donors into uninfected recipients carries >90% risk of viral transmission. [50][51][52][53] DAAs provide successful treatment after transplantation.…”

“…With an effective HCV treatment now available and an increase in HCV‐infected donors, usually younger and with better organ function, transplantation of these organs to un‐infected recipients started to be considered. Thus, a marked increase in heart transplant programs that use of HCV NAT‐positive donors has been seen in the United States since 2017, although with significant regional and center‐specific variations 47–49 . Transplantation of hearts from HCV‐viremic donors into uninfected recipients carries >90% risk of viral transmission 50–53 .…”

Hepatitis C viraemic organs in solid organ transplantation

“…Similarly, national utilization rates of anti-HCV-positive viremic and nonviremic donor hearts in 2019 was the same as anti-HCV-negative donor hearts 54.55 . Lastly, significant regional and center variation in discard and transplant rates J o u r n a l P r e -p r o o f of anti-HCV-positive and viremic organs has been described, suggesting that more uniform national and international policies may increase utilization even further 53,55,56 .…”