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The advent of direct acting antivirals has allowed for utilization of HCV NAT+ donors with good short-term outcomes. The goal of this study was to compare clinical outcomes among heart transplant recipients who received hearts from HCV NAT+ donors to those from NAT- donors. We examined the UNOS registry of all primary orthotopic adult heart transplants from March 15, 2015 to August 31, 2021 and identified their donors as HCV NAT+ or NAT-. Those with multiorgan transplants or waitlisted for other organs were excluded. Baseline characteristics, three-year survival, and treatment for rejection at one year were compared between the two groups. Of 16,491 heart transplants meeting study criteria, 729(4%) hearts came from HCV NAT+ donors. HCV NAT+ donors were older (34±8 vs 32±11 years, p<0.01), more likely males(75% vs 70%, p<0.01), white race(83% vs 63%, p<0.01), and blood group O(60% vs 50%, p<0.01). They were more likely to have drug use as cause of death(59% vs 18%, p<0.01) and classified as CDC high risk (87% vs 29%, p<0.01). Recipients were more likely blood group O(48% vs 39%, p<0.01) and have positive hepatitis C serologies(5% vs 2%, p<0.01). They were less likely Status 1A (58% vs 67%, p<0.01) or Status 1 (4% vs 9%, p<0.01) or 2 (36% vs 48%, p<0.01). Distance traveled (241 vs 139 nautical miles, p<0.01) and ischemia times (3.48 vs 3.23 hours, p<0.01) were greater in the HCV NAT+ group, while wait list duration was similar (69 vs 69 days, p=0.20). Three-year survival (87% vs 85%,Figure; log-rank p=0.26) and treatment for rejection in first year post transplant (19% vs 18%, p=0.72) were not significantly different between the two groups. HCV NAT+ donors are being increasingly used for heart transplantation, particularly for lower status recipients with otherwise longer wait times. Three-year survival and treatment for rejection at one year are comparable to those from HCV NAT- donors. Therefore, HCV NAT+ donor hearts should continue to be utilized with monitoring of long-term outcomes. [ABSTRACT FROM AUTHOR]

With the advent of direct acting antivirals, hepatitis C viremic donors are being increasingly used for heart transplantation. Single institutions have reported increased incidence of acute rejection when utilizing these hearts. The goal of this study was to evaluate one-year acute rejection following heart transplant from HCV viremic donors. We conducted retrospective review of UNOS of all primary adult heart transplants conducted between March 31, 2015 and June 30, 2020, excluding recipients with prior transplants, multiorgan transplants, or those waitlisted for other organs. Donors were dichotomized as being HCV NAT+ or HCV NAT-. One-year acute rejection requiring treatment was compared and evaluated by univariable and multivariable logistic regression. Of 11,058 heart transplant recipients in our cohort during the study period, 432 (3.9%) came from HCV NAT+ donors. HCV NAT+ donors were significantly older (34±8 vs 32±11 years, p<0.01), more likely to be white (82% vs 64%, p<0.01), blood group O (61% vs 49%, p<0.01), CDC high risk (88% vs 30%, p<0.01), and have drug use as cause of death (61% vs 17%, p<0.01). Recipients in the HCV NAT+ group were older [58(49-64) vs 56 (46-63) years, p<0.01), had higher ischemic times (3.5±1.0 vs 3.1±1.1 hours, p<0.01) and were more likely to be blood group O (49% vs 39%, p<0.01) and HCV antibody positive (5% vs 2%, p<0.01). They were less likely to be on inotropes (31% vs 37%, p<0.01) or any life support (81% vs 86%, p<0.01) at the time of transplant. Incidence of acute rejection requiring treatment within one year was not significantly different between the two groups (21% HCV NAT+ vs 19% HCV NAT-, p = 0.31). Donor HCV NAT+ was not associated with one-year acute rejection on either univariable (OR 1.13, 95% CI 0.89-1.43) or multivariable (aOR 1.08, 95% CI 0.84-1.41) logistic regression. Despite single center studies reporting potential increases in acute rejection when utilizing HCV-viremic donor hearts for transplantation, our UNOS registry analysis did not demonstrate increased treatment for acute rejection after one year. We should continue to utilize these donor hearts with careful surveillance and monitoring of long-term outcomes. [ABSTRACT FROM AUTHOR]

With the advent of a cure for HCV, HCV NAT+ donor lungs are being increasingly utilized for transplantation, but their outcomes are understudied. Our goal was to examine one-year survival of lung transplant recipients from HCV NAT+ donors. We conducted retrospective review of all primary adult lung transplant recipients in the UNOS registry between January 1, 2015 and June 12, 2020. Donors were identified as being HCV NAT+ or HCV NAT-. One-year survival was examined with the Kaplan Meier method and a multivariable Cox-proportional hazards model. Of 11809 lung transplants performed during the study period, 222 (2%) came from HCV NAT+ donors. HCV NAT+ donors tended to be younger (33±8 vs 35±14 yrs, p=0.01) and were more likely to be white (82% vs 61%, p<0.01), blood group O (61% vs 50%, p<0.01), CDC high risk (84% vs 24%, p<0.01), and have drug intoxication as cause of death (61% vs 12%, p<0.01). Recipients of HCV NAT+ donor lungs were less likely to have diabetes (10% vs 20%, p<0.01), cystic fibrosis (5% vs 9%, p<0.01), IPF (28% vs 36%, p<0.01), have chronic steroid use (32% vs 44%) or be treated with IV antibiotics 2 weeks prior transplant (5% vs 12%, p=0.02). They had lower LAS scores (42±15 vs 48 ± 18, p<0.01), oxygen requirements at rest (4.5 vs 5.5 L, p<0.01), and were more likely to receive double lungs (83% vs 74%, p<0.01). One-year survival was not significantly different among recipients of HCV NAT+ and NAT- donor lungs on univariate (HR 1.00, 95% CI 0.62-1.62, p=0.98) or multivariate analysis (aHR 0.94, 95% CI 0.53-1.67, p=0.84). Incidence of treatment for acute rejection at one year was also not significantly different (23% vs 23%, p=0.86). Despite coming from high-risk donors, HCV NAT+ lungs have similar one-year survival and acute rejection as those coming from HCV NAT- donors. While longer-term studies are necessary, this report supports the use of NAT+ donor lungs among lung transplant candidates. [ABSTRACT FROM AUTHOR]