Heart Transplant From Organ Donor With Hepatitis C Associated With Decreased Survival
Heart transplant patients who receive a donor heart from a person with hepatitis C have a lower rate of survival, according to a study in the October 18 issue of JAMA.
A shortage of cardiac organ donors results in a substantial number of deaths among persons awaiting cardiac transplantation. One potential approach for increasing the availability of donors is to broaden the criteria used to identify appropriate donors. For example, the cardiac donor pool could be expanded by using donors with hepatitis C virus (HCV) infection. Hearts from donors infected with HCV carry a substantial risk of transmission of HCV to the recipient, and high rates of subsequent liver enzyme abnormalities have been observed, according to background information in the article. The effect on patient survival has not been clear.
Leanne B. Gasink, M.D., M.S.C.E., of the University of Pennsylvania School of Medicine, Philadelphia, and colleagues conducted a study to determine the relationship between donor HCV status and survival in cardiac transplant recipients. The study included data from the Scientific Registry of Transplant Recipients. Adult heart transplant patients who received their transplants between April 1994 and July 2003 were eligible for inclusion. Of 10,915 patients meeting entry criteria, 261 received an HCV-positive donor heart.
The researchers found that the rate of death was higher among recipients of hearts from HCV-positive donors compared with recipients of hearts from HCV-negative donors at 1 year (16.9 percent vs. 8.2 percent), 5 years (41.8 percent vs. 18.5 percent), and 10 years (50.6 percent vs. 24.3 percent). At 1, 5, and 10 years, survival rates were 83 percent, 53 percent, and 25 percent for recipients of HCV-positive donor hearts, and 92 percent, 77 percent, and 53 percent for recipients of HCV-negative donor hearts, respectively. This association appears to be independent of recipient HCV status and age. Recipients of HCV-positive donor hearts were more likely to die of liver disease and coronary vasculopathy (disease of the coronary arteries).
"Preferential allocation of HCV-positive donors to HCV-positive recipients and/or older recipients is not warranted," the authors conclude. (JAMA. 2006;296:1843-1850).
Editor's Note: Internal funds provided by Division of Cardiology at the University of Pennsylvania were used to obtain data from the Scientific Registry of Transplant Recipients (SRTR). Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
In an accompanying editorial, Amir A. Qamar, M.D., and Robert H. Rubin, M.D., of Harvard Medical School and Brigham and Women's Hospital, Boston, comment on the findings of Gasink and colleagues.
"The question that remains is how patients should be managed in the face of a potential organ donor who is HCV positive. The results of the study by Gasink et al, demonstrating a survival disadvantage among heart transplant recipients who had HCV-positive donors, provide support for the position that transplanting hearts from HCV-positive donors should be avoided if possible. Studies in other organ recipients suggest similar results. Exceptions could be made for critically ill patients who will not survive without a transplant." (JAMA. 2006;296:1900-1901).