Outcomes of Over 1000 Heart Transplants Using Hepatitis C–Positive Donors in the Modern Era

Advances in hepatitis C (HCV) treatment and the ongoing opioid epidemic have made HCV-positive donors increasingly available for heart transplantation (HT). This analysis reports outcomes of over 1,000 HCV-positive HTs in the United States in the modern era.The United Network of Organ Sharing registry was used to identify HTs between 2015-2021. Recipients were grouped by donor HCV status and by nucleic acid amplification test (NAT) positivity. The primary outcome was one-year mortality, and secondary outcomes included three-year mortality. A sub-analysis compared HCV-positive HT outcomes between NAT-positive and NAT-negative donors. Risk-adjustment was performed using Cox regression. Kaplan-Meier analysis was used to estimate survival.The frequency of HCV-positive HT increased from 0.12% of HT in 2015 to 12.9% in 2021 (p0.001). Of 16,648 HTs, 1,170 (7.0%) used an organ from an HCV-positive donor. Recipients of HCV-positive organs were more likely to be HCV-seropositive, older, and white. Unadjusted one- and three-year survival were not significantly different between recipients of HCV-negative and HCV-positive organs. After risk adjustment, HCV-positive donor status was not associated with an elevated risk for one-year (HR 0.92, 95% CI[0.71-1.19], p=0.518) or three-year mortality. Among HCV-positive HT, 772 (61.7%) were NAT+. After risk-adjustment, NAT-positivity did not impact one-year mortality.The proportion of HCV-positive HTs has increased over a hundredfold in recent years. This analysis of the United States experience demonstrates that recipients of HCV-positive hearts, including those that are NAT-positive, have acceptable outcomes with similar early to mid-term survival as recipients of HCV-negative organs.