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HCV-Positive Donor Hearts Associated with Worse Survival

A donated heart infected with hepatitis C virus conferred a survival disadvantage, even after adjustment for recipient illness severity, age, and pretransplant HCV status.

The limited donor pool for heart transplantation has been expanded by allowing hearts infected with hepatitis C virus (HCV) to be donated to high-risk recipients. However, such donations increase the risks for HCV transmission and liver-enzyme abnormalities in recipients. To learn more about outcomes in recipients of HCV-positive hearts, researchers analyzed data from all 10,915 U.S. adults who underwent heart transplantation from April 1994 through July 2003; a total of 261 patients received HCV-positive donor hearts.

Compared with recipients of HCV-negative hearts, recipients of HCV-positive hearts had significantly higher all-cause mortality rates at 1 year (17% vs. 8%), 5 years (42% vs. 19%), and 10 years (51% vs. 24%). After adjustment for multiple potential confounders (including severity of illness, recipient HCV status, age, and the likelihood of receiving an HCV-positive heart), mortality risk remained about twice as high among recipients of HCV-positive hearts as among recipients of HCV-negative hearts, even in patients age 60 or older.

Comment: Current guidelines support the use of HCV-positive donors in high-risk patients who need heart transplants. The current study challenges that recommendation by documenting greater mortality risk in recipients of HCV-positive (vs. HCV-negative) hearts, even after adjustment for severity of illness, age, and other potential confounders. The editorialists suggest that HCV-positive hearts be given only to critically ill patients who would not survive without immediate transplantation. Risks from receiving an HCV-positive donor heart should be weighed on a case-by-case basis. It’s unclear what effect this study will have on current guidelines.

— JoAnne M. Foody, MD

Published in Journal Watch Cardiology December 13, 2006

Citation(s):

Gasink LB et al. Hepatitis C virus seropositivity in organ donors and survival in heart transplant recipients. JAMA 2006 Oct 18; 296:1843-50.

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• Medline abstract (Free)

Qamar AA and Rubin RH. Poorer outcomes for recipients of heart allografts from HCV-positive donors: Opening the silos. JAMA 2006 Oct 18; 296:1900-1.

• Original article (Subscription may be required)
• Medline abstract (Free)