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 18 November 2017

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News

Hep C positivity in organ donors reduces recipients' survival

Receipt of a heart from an Hep C-positive donor decreases survival in heart transplant recipients, shows this week's Journal of the American Medical Association..

News image

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Although liberalization of donor criteria could expand the donor pool, the use of certain ‘marginal donors', such as those who are Hepatitis C positive, is controversial.

Little is known about the effect of donor Hepatitis C positivity on survival in cardiac transplantation.

Dr Leanne Gasink and colleagues from Philadelphia examined the association between donor Hepatitis C positivity.

The research team also assessed survival among heart transplant recipients.

The team determined the effects of recipient age and recipient Hepatitis C status on this association.

A multicenter cohort study was performed using the US Scientific Registry of Transplant Recipients.

Adult heart transplant patients who received their transplants between 1994, and 2003, were eligible for inclusion.

The 10-year survival rate for Hep C-positive donor recipients was 25%
Journal of the American Medical Association

The researcher's main outcome was all-cause mortality.

The team found that of 10,915 patients meeting entry criteria, 261 received an Hepatitis C-positive donor heart.

Mortality was higher among recipients of Hepatitis C-positive donor hearts at 1 year, 5 years, and 10 years.

Using Kaplan-Meier methods, the team noted that 1-, 5-, and 10-year survival rates were 83%, 53% and 25% for Hepatitis C-positive donor heart recipients.

For Hepatitis C-negative donor heart recipients, the 1-, 5-, and 10- year survival rates were 92%, 77%, and 53%.

The team observed that recipients of Hepatitis C-positive donor hearts were more likely to die of liver disease and coronary vasculopathy.

After propensity matching, the overall hazard ratio associated with receipt of an Hepatitis C-positive donor heart was about 2.

The researchers showed with stratified analyses that hazard ratios did not vary by recipient Hepatitis C status or by recipient age.

Dr Gasink's team concludes, “Receipt of a heart from an Hepatitis C-positive donor is associated with decreased survival in heart transplant recipients.”

“This association appears to be independent of recipient Hepatitis C status and age.”

“Preferential allocation of Hepatitis C-positive donors to Hepatitis C-positive recipients and/or older recipients is not warranted.”

JAMA 2006: 296: 1843-50
20 October 2006

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