Utilization of hepatitis C virus infected donors in heart transplant recipients with elevated MELD‐XI score.

Background: The advent of direct‐acting antivirals has helped to increase the safe utilization of organs from hepatitis C virus positive (HCV+) donors. However, the outcomes of heart transplantation (HT) using an HCV+ donor are unclear in recipients with underlying liver disease represented by an elevated model for end‐stage liver disease excluding international normalized ratio (MELD‐XI). Methods: The United Network of Organ Sharing database was queried from Jan 2016 to Dec 2021. Post‐transplant outcomes stratified by recipient MELD‐XI score (low <10.37, medium, 10.38–13.39, and high >13.4) was compared between patients with HT from HCV+ (N = 792) and patients with HT from HCV‐negative donors (N = 15,266). Results: The median MELD‐XI score was comparable (HCV+, 12.1, vs. HCV‐negative, 11.8, p =.37). In the HCV+ group, donors were older (33 vs. 31 years, p <.001). Ischemic time of donor hearts (3.48 vs. 3.28 h, p <.001) and travel distance (250 vs. 157 miles, p <.001) were longer in HCV+ group. In the Kaplan Meier analysis with a median follow‐up of 750 days, survival was comparable between the two groups (2‐year survival, MELD‐XI Low: HCV+, 92.4 ± 3.6% vs. HCV‐negative, 91.1 ±.8%, p =.83, Medium: HCV+ 89.2 ± 4.3% vs. HCV‐negative, 88.2 ± 1.0%, p =.68, and High: HCV+, 84.9 ± 4.5% vs. HCV‐negative, 84.6 ± 1.1%, p =.75) In multivariate Cox hazard models, HCV donors were not associated with mortality in each MELD‐XI subgroup (Low: adjusted hazard ratio (aHR), 1.02, p =.94; Medium: aHR,.95, p =.81; and High: aHR,.93, p =.68). Conclusion: Utilization of HCV+ hearts was not associated with an increased risk of adverse outcomes in recipients with an elevated MELD‐ XI score. [ABSTRACT FROM AUTHOR]