Despite ongoing donor shortages in heart transplant, donor candidates arising from drug overdose (OD) are increasingly prevalent. These donors carry a high preponderance of now curable Hepatitis C virus (HCV). This study investigates temporal trends and regional variability in HCV+ allograft use in heart transplant, assessing the relation of HCV+ graft use on OD donor usage as well as waitlist and post-transplant outcomes.
A retrospective review of the United Network for Organ Sharing (UNOS) database assessed adults listed for heart transplant. Patients were stratified both temporally into pre-HCV and HCV eras related to HCV+ graft use trends and regionally by degree of HCV+ allograft use. Regions of high HCV+ donor use were associated with an increase in OD donor access by 7.8% across eras compared to 0.4% in low HCV+ donor use regions. One-year waitlist mortality decreased from 4.7% to 2.5% across eras in high HCV+ donor use regions (p=0.001) and remained similar in low HCV+ donor use regions (3.0% vs. 2.4%, p=0.244.). Post-transplant survival at 1 year remained similar across eras.
HCV+ donor allograft use can help optimize donor utilization, decreasing waitlist mortality without compromising early survival. Ongoing assessment is essential to ensure long-term safety and efficacy of utilizing HCV+ donors.

Copyright © 2021. Published by Elsevier Inc.