With the advent of direct‐acting antiviral agents, there has been a rapid rise in hepatitis C virus–infected (HCV+) heart transplantation. We aimed to understand local and regional differences in utilization and allocation of HCV+ hearts. Using United Network for Organ Sharing (UNOS) de‐identified data from January 1, 2016 to September 30, 2019 we compared trends in the utilization rates (hearts transplanted/donors recovered) of HCV‐uninfected (HCV−) to those of HCV+ nonviremic (HCV‐NV) and viremic (HCV‐V) hearts nationally and by UNOS region. We also evaluated allocation rates (hearts successfully allocated/donors recovered) by organ procurement organization (OPO). We found that (1) in 2019, national utilization rates for HCV‐NV and HCV‐V hearts were the same as HCV− hearts (27.6% for HCV‐NV, 30.9 for HCV‐V, and 31.7% for HCV−, P = .277); (2) utilization rates of HCV‐NV hearts were low in regions 3 and 4 and of HCV‐V hearts in regions 3, 4, and 8 even in the contemporary period since 2018; and (3) there was marked variability in allocation of HCV+ hearts at the OPO level even within the same UNOS region. We conclude that despite national strides in the utilization of HCV+ hearts for transplantation, more aggressive allocation of HCV+ hearts at the OPO level may still significantly affect the organ shortage.

中文翻译：

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用于移植的丙型肝炎病毒感染心脏的利用和分配的局部和区域差异

随着直接抗病毒药物的出现，丙型肝炎病毒感染 (HCV+) 心脏移植的数量迅速增加。我们旨在了解 HCV+ 心脏的利用和分配方面的地方和区域差异。使用器官共享联合网络 (UNOS) 从 2016 年 1 月 1 日到 2019 年 9 月 30 日的去识别化数据，我们比较了未感染 HCV (HCV-) 与 HCV+ 非病毒血症的利用率趋势（移植的心脏/恢复的供体） (HCV-NV) 和病毒血症 (HCV-V) 心脏在全国和 UNOS 地区。我们还评估了器官采购组织 (OPO) 的分配率（心脏成功分配/捐赠者回收）。我们发现 (1) 2019 年，HCV-NV 和 HCV-V 心脏的全国使用率​​与 HCV- 心脏相同（HCV-NV 为 27.6%，HCV-V 为 30.9，HCV- 为 31.7%，P  = .277); (2) 自 2018 年以来，HCV-NV 心脏在 3 区和 4 区的利用率较低，HCV-V 心脏在 3、4 和 8 区的利用率较低；(3) 即使在同一 UNOS 区域内，在 OPO 水平上 HCV+ 心脏的分配也存在显着差异。我们的结论是，尽管国家在利用 HCV+ 心脏进行移植方面取得了长足进步，但在 OPO 水平上更积极地分配 HCV+ 心脏可能仍会显着影响器官短缺。