BACKGROUND

Previous studies suggest that direct-acting anti-virals (DAAs) for the treatment of hepatitis C virus (HCV) infection permits the transplantation of HCV-viremic donor organs in uninfected recipients. This opportunity may expand the donor pool. We assessed the impact of using HCV nucleic acid test–positive (NAT+) donor hearts on heart transplant (HTx) waitlist time and transplant rate.

METHODS

We retrospectively analyzed 156 patients who were listed for HTx from October 2015 through October 2018. Patients were stratified into 2 periods centered on April 27, 2017, when the protocol to accept HCV NAT+ donor organs for transplantation in non–HCV-infected recipients began, Period 1 (October 27, 2015 to April 26, 2017) and Period 2 (April 27, 2017 to October 26, 2018).

RESULTS

In Period 1, 57 of the 71 patients on the HTx waitlist were transplanted, whereas in Period 2, 57 of the 85 patients were transplanted. The median waitlist time to transplant decreased from 63.1 days in Period 1 to 34.1 days in Period 2 (p = 0.002). The transplant rate increased from 168.2 per 100 patient-years in Period 1 to 280.0 per 100 patient-years in Period 2 (incidence rate ratio 2.0, 95% CI 1.2–3.3; p = 0.006). Waitlist mortality rate, hospital stay post-transplantation, and post-transplant mortality did not differ significantly between the time periods. Nineteen patients received HCV NAT+ donor hearts. The short-term post-transplant outcomes were similar between the recipients who received HCV NAT+ and HCV NAT- donor hearts.

CONCLUSIONS

This single-center retrospective analysis suggests that the use of HCV NAT+ donor hearts may result in a reduced HTx waitlist time and an increased transplant rate. In addition, transplanting HCV NAT+ donor hearts into non–HCV-infected recipients, followed by DAAs, can provide acceptable short-term post-transplant outcomes.

中文翻译：

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使用丙型肝炎病毒核酸测试阳性的供体心脏对心脏移植候补时间和移植率的影响。

背景

先前的研究表明，用于治疗丙型肝炎病毒（HCV）感染的直接作用抗病毒药物（DAA）可以在未感染的受体中移植HCV病毒性供体器官。这个机会可能会扩大捐助者的数量。我们评估了使用HCV核酸测试阳性（NAT +）供体心脏对心脏移植（HTx）候补时间和移植率的影响。

方法

我们回顾性分析了2015年10月至2018年10月期间被列为HTx的156例患者。这些患者被分为2个阶段（以2017年4月27日为中心），当时开始接受在非HCV感染者中接受HCV NAT +供体器官移植的方案，期间1（2015年10月27日至2017年4月26日）和期间2（2017年4月27日至2018年10月26日）。

结果

在第1阶段，HTx等待列表中的71位患者中有57位被移植，而在第2阶段，这85位患者中有57位被移植。候补时间中位数从第1阶段的63.1天减少到第2阶段的34.1天（p  = 0.002）。移植率从第1阶段的每100病人年的168.2增加到第2阶段的每100病人年的280.0（发生率比2.0，95％CI 1.2-3.3；p  = 0.006）。在两个时间段之间，候补名单的死亡率，移植后的住院天数和移植后的死亡率没有显着差异。19名患者接受了HCV NAT +供体心脏。接受HCV NAT +和HCV NAT-供体心脏的接受者之间的短期移植后结果相似。

结论

这项单中心回顾性分析表明，使用HCV NAT +供体心脏可能会减少HTx等待列表时间并提高移植率。此外，将HCV NAT +供体心脏移植到未感染HCV的接受者中，然后移植DAA，可以提供可接受的短期移植后结果。