Utilization of Hepatitis C Virus Infected Donors in Heart Transplant Recipients with Elevated MELD-XI Score

Authors

Rahim Hirani, New York Medical College, Valhalla, New York, USA.
Kenji Okumura, Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA.
Ameesh Isath, Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA.
Vasiliki Gregory, New York Medical College, Valhalla, New York, USA.
Shazli Khan, Department of Cardiology, Westchester Medical Center, Valhalla, New York, USA.
Abhay Dhand, Transplant Infectious Disease, Department of Medicine, Westchester Medical Center, Valhalla, New York, USA.Follow
Gregg M. Lanier, New York Medical College, Valhalla, New York, USA.Follow
David Spielvogel, New York Medical College, Valhalla, New York, USA.
Masashi Kai, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.Follow
Suguru Ohira, New York Medical College, Valhalla, New York, USA.Follow

Author Type(s)

Student, Resident/Fellow, Faculty

DOI

https://doi.org/10.1111/ctr.15124

Journal Title

Clinical Transplantation

First Page

e15124

Document Type

Article

Publication Date

12-1-2023

Department

Medicine

Second Department

Surgery

Abstract

BACKGROUND: The advent of direct-acting antivirals has helped to increase the safe utilization of organs from hepatitis C virus positive (HCV+) donors. However, the outcomes of heart transplantation (HT) using an HCV+ donor are unclear in recipients with underlying liver disease represented by an elevated model for end-stage liver disease excluding international normalized ratio (MELD-XI). METHODS: The United Network of Organ Sharing database was queried from Jan 2016 to Dec 2021. Post-transplant outcomes stratified by recipient MELD-XI score (low <10.37, medium, 10.38-13.39, and high >13.4) was compared between patients with HT from HCV+ (N = 792) and patients with HT from HCV-negative donors (N = 15,266). RESULTS: The median MELD-XI score was comparable (HCV+, 12.1, vs. HCV-negative, 11.8, p = .37). In the HCV+ group, donors were older (33 vs. 31 years, p < .001). Ischemic time of donor hearts (3.48 vs. 3.28 h, p < .001) and travel distance (250 vs. 157 miles, p < .001) were longer in HCV+ group. In the Kaplan Meier analysis with a median follow-up of 750 days, survival was comparable between the two groups (2-year survival, MELD-XI Low: HCV+, 92.4 ± 3.6% vs. HCV-negative, 91.1 ±.8%, p = .83, Medium: HCV+ 89.2 ± 4.3% vs. HCV-negative, 88.2 ± 1.0%, p = .68, and High: HCV+, 84.9 ± 4.5% vs. HCV-negative, 84.6 ± 1.1%, p = .75) In multivariate Cox hazard models, HCV donors were not associated with mortality in each MELD-XI subgroup (Low: adjusted hazard ratio (aHR), 1.02, p = .94; Medium: aHR, .95, p = .81; and High: aHR, .93, p = .68). CONCLUSION: Utilization of HCV+ hearts was not associated with an increased risk of adverse outcomes in recipients with an elevated MELD- XI score.

Recommended Citation

Hirani, R., Okumura, K., Isath, A., Gregory, V., Khan, S., Dhand, A., Lanier, G. M., Spielvogel, D., Kai, M., & Ohira, S. (2023). Utilization of Hepatitis C Virus Infected Donors in Heart Transplant Recipients with Elevated MELD-XI Score. Clinical Transplantation, 37 (12), e15124. https://doi.org/https://doi.org/10.1111/ctr.15124