Epidemiology

Heart transplants from HCV-positive donors linked to lower recipient survival

Last Updated: 2006-10-17 16:00:28 -0400 (Reuters Health)

NEW YORK (Reuters Health) - The risk of dying after heart transplantation is approximately doubled when the donor is positive for hepatitis C virus (HCV), according to results of a study published in the Journal of the American Medical Association for October18.

The 2001 American Heart Association consensus conference report states that HCV-positive donors "may be appropriate for selected higher-risk recipients," and others have suggested that HCV donors should be allocated to older patients.

However, lead author Dr. Leanne B. Gasink and colleagues note, to date there has been little attention paid to the effect of HCV donor positivity on survival in heart transplantation.

To establish firmer information, Dr. Gasink, from the University of Pennsylvania in Philadelphia, and her associates analyzed data from the Scientific Registry of Transplant Recipients. Their study cohort comprised 10,915 adults who received a heart transplant between 1994 and 2003 and were followed until August of 2004. Included were 261 patients who had received a heart from an HCV-positive donor.

Overall, the mortality rate was 59.6% among recipients of HCV-positive donor hearts versus 24.3% among those receiving hearts from HCV-negative donors (p < 0.001). The disparity in mortality became apparent as early as the first year (16.9% versus 8.2%) and remained elevated throughout follow-up.

HCV-positive heart recipients were more likely than their counterparts to die due to viral hepatitis, liver failure, or coronary artery disease, the authors observed. Only death due to graft failure was more common among unexposed recipients.

The mortality risk associated with receipt of an HCV-positive donor heart remained elevated regardless of the recipient's own HCV status or the recipient's age.

Dr. Gasink's group concludes, "Our study demonstrates a survival disadvantage among heart recipients with HCV-positive donor hearts." They add, "Preferential allocation of HCV-positive donors to older cardiac transplant candidates is not appropriate."

Editorialists at Harvard Medical School in Boston advise that, rather than scrapping the use of HCV-positive organs for transplantation altogether, a special regimen should be developed that would allow the use of such organs with greater safety.

For example, Dr. Amir A. Qamar and Dr. Robert H. Rubin suggest, a trial of pegylated interferon plus ribavirin in recipients should be considered. They also recommend avoidance of the more aggressive HCV genotype 1b and elimination of factors promoting HCV, such as high-dose immunosuppression and iron overload.

Until these avenues have been explored, they add, "the use of hearts from HCV-positive donors should be restricted to the critically ill who would not survive without an immediate transplant."

JAMA 2006;296:1843-1850,1900-1901.