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.”