Background:Strategies to improve donor heart utilization are required in the setting of limited donor availability. One innovative strategy is to consider the use of hepatitis C viremic (HCV) nucleic acid amplification test positive donors in hepatitis C-negative recipients, given the availability of highly effective direct acting antiviral agents. We utilized United Network for Organ Sharing data to evaluate the geographic distribution, clinical characteristics, and post-transplant outcomes of HCV+ donor hearts.Methods and Results:The United Network for Organ Sharing registry was queried for all HCV+ recovered donors and those considered for heart donation classified by sex, age group, United Network for Organ Sharing region, and cause of death from January 1, 2014, to December 31, 2017. Propensity score matching (3:1) was applied to the recipients based on the index for mortality prediction after cardiac transplantation score and donor risk index. A total of 1306 HCV+ donors were recovered from 2014 to 2017 of whom 1078 (82.5%) were 18 to 49 and predominantly from the Appalachia region (United Network for Organ Sharing regions 2, 3, and 11). A total of 64 (5%) HCV+ donor hearts were transplanted in this interval. The match-adjusted risk difference in survival was estimated to be 0.87% (P=0.83) at 12 months.Conclusions:To meet the demands of heart transplantation, we must consider additional strategies to expand the donor pool. From 2014 to 2017, despite availability of highly effective direct acting antiviral therapy, only 5% of HCV+ donor hearts were accepted for transplantation. National efforts may be required to capitalize on this resource while we continue to carefully monitor the safety of this novel approach.

中文翻译：

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丙型肝炎病毒捐赠者心脏的当前使用

背景：在供体数量有限的情况下，需要采取一些策略来提高供体心脏的利用率。一种创新策略是考虑到可以使用高效直接作用的抗病毒药物，考虑在丙型肝炎阴性患者中使用丙型肝炎病毒血症（HCV）核酸扩增试验阳性供体。我们利用联合器官共享网络数据评估了HCV +供体心脏的地理分布，临床特征和移植后结果。 2014年1月1日至2017年12月31日按性别，年龄段，器官共享联合网络区域和死因分类的捐赠。倾向得分匹配（3：1）根据心脏移植术后死亡率预测指数和供体风险指数应用于接受者。从2014年到2017年，共回收了1306例HCV +供体，其中1078例（82.5％）为18至49人，主要来自阿巴拉契亚地区（器官共享联合网络第2、3和11个地区）。在此间隔内总共移植了64（5％）HCV +供体心脏。经匹配调整后的生存风险差异估计为0.87％（P = 0.83）在12个月时。结论：为了满足心脏移植的需求，我们必须考虑其他策略来扩大供体库。从2014年到2017年，尽管可以使用高效的直接作用抗病毒治疗，但仅5％的HCV +供体心脏被接受移植。在我们继续仔细监视这种新颖方法的安全性的同时，可能需要国家努力才能利用这一资源。