Newer, more effective antivirals mean hearts from donors with HCV are a viable option for transplantation. Rising opioid-related deaths means there are more of these donors available.
Until very recently, hearts from donors testing positive for the hepatitis C virus (HCV) were seen as too risky to be used in transplantation. Doctors were fearful of introducing a new virus into the system of a patient already burdened with poor health, leading to a dearth of usable hearts and a long wait list. But a study recently published in the Journal of the American Heart Association revealed that using hearts from HCV-positive donors poses no unusual risk to recipients by the 1-year anniversary of transplantation.
A team of investigators at the Heart and Vascular Institute at the University of Pittsburgh Medical Center evaluated data on the nearly 8000 adults who underwent heart transplants in the United States between 2016 and 2018. Out of that group, 343, or 4.4%, received hearts from HCV-positive donors. Their outcomes did not differ significantly from the outcomes of patients who received hearts from HCV-negative donors.
Among the findings: 91.1% of recipients of HCV-negative hearts were alive 1 year after surgery, while 90.2% of recipients of HCV-positive hearts were alive. At 1 year, slightly less than a fifth (19.6%) of recipients of HCV-negative hearts experienced drug-treated organ rejection, compared with slightly more than a fifth (21.6%) of recipients of hearts from HCV-positive donors. Also similar in both groups were rates of stroke, rates of dialysis, and number of days spent in the hospital.
Experts say the percentage of medical centers performing heart transplants using HCV-positive donors has risen substantially in just the last few years, to roughly 28% of all institutions today. One reason is the availability of newer, more effective drugs to treat hepatitis C that may occur in recipients. “Recently, there has been a resurgence of interest in cardiac transplantation using HCV+ donors with the advent of direct-acting antiviral drugs, with low reported rates of seroconversion and acceptable posttransplant survival in small series,” the authors wrote in the study report.
Another factor in the increasing use of HCV-positive hearts for transplants is a greater number of HCV-positive donors. “The potential pool of HCV+ donors is substantial and largely reflective of the rising opioid epidemic in the United States,” the authors wrote. “An analysis of heart transplants performed between 2010 and 2017 in the United States showed that 11% were from donors that overdosed on drugs, and these donors were more likely to be HCV+.”
Although the study offers solid evidence that using hearts from HCV-positive donors is preferable to letting patients languish on waiting lists, as a retrospective analysis the study has some limitations. It is unknown how many recipients of hearts from HCV-positive donors developed hepatitis C, meaning there is no data on antiviral HCV treatment in the study population. The patients also were not studied past 1 year. In their report, the investigators pointed out that prior studies found a correlation between hearts from HCV-positive donors and allograft coronary disease, with 1 study showing that recipients of these hearts are 3 times more likely to develop any abnormalities of the blood vessels and 9 times more likely to suffer from advanced blood vessel disease.
Other organs besides the heart have been found to be safe for transplantation from HCV-positive donors into HCV-negative recipients. A notable study at Penn Medicine showed that kidneys transplanted under these circumstances functioned well and produced good outcomes.