Outcomes of Adult Heart Transplantation Using Hepatitis C–Positive Donors

BACKGROUND: This study evaluated the impact of hepatitis C–positive (HCV+) donors on outcomes of heart transplantation in the United States. METHODS AND RESULTS: Adults undergoing isolated heart transplantation in the United States between January 1, 2016, and December 31, 2018, were included. The primary outcome was 1‐year post‐transplant survival. Multivariable Cox regression and 2:1 propensity matching were used to compare outcomes between transplants with HCV+ and hepatitis C–negative (HCV−) donors. A subanalysis was performed to evaluate the impact of nucleic acid amplification test positivity on outcomes. Of 7889 isolated heart transplants performed during the study period, 343 (4.4%) used HCV+ donors. Overall unadjusted 1‐year posttransplant survival was not statistically different between HCV− versus HCV+ donors (91.1% versus 90.2%; P=0.86), a finding that persisted after risk adjustment (hazard ratio, 1.05; 95% CI, 0.70–1.58; P=0.80). Propensity matching resulted in 675 well‐balanced patients (437 HCV− and 238 HCV+). Overall 1‐year posttransplant survival was not statistically different in propensity‐matched analysis (89.8% HCV− versus 89.2% HCV+; P=0.88). Rates of 1‐year drug‐treated rejection (21.1% versus 22.1%; P=0.84), postoperative dialysis (11.4% versus 14.7%; P=0.22), and stroke (4.6% versus 2.1%; P=0.10) were also not statistically different between HCV− and HCV+ groups, respectively. Outcomes were not statistically different between nucleic acid amplification test–negative and nucleic acid amplification test–positive HCV+ donors. CONCLUSIONS: Adult heart transplants using HCV+ donors, including those that are nucleic acid amplification test positive, can be performed without an adverse impact on 1‐year survival. Wider implementation of protocols for using HCV+ donors and an assessment of longer‐term outcomes including seroconversion rates will be important in maximizing the effect of HCV+ donors on national donor shortages.