title: Hepatitis C virus seropositivity in organ donors and survival in heart transplant recipients.
abstract: BACKGROUND
  Although liberalization of donor criteria could expand the donor pool, the use of certain "marginal donors," such as those who are hepatitis C virus (HCV) positive, is controversial. Little is known about the effect of donor HCV positivity on survival in cardiac transplantation.
  
  
  OBJECTIVE
  To examine the association between donor HCV positivity and survival among heart transplant recipients and to determine the effects of recipient age and recipient HCV status on this association.
  
  
  METHODS
  A multicenter cohort study was performed using the US Scientific Registry of Transplant Recipients. Adult heart transplant patients who received their transplants between April 1, 1994, and July 31, 2003, were eligible for inclusion.
  
  
  METHODS
  All-cause mortality.
  
  
  RESULTS
  Of 10 915 patients meeting entry criteria, 261 received an HCV-positive donor heart. Mortality was higher among recipients of HCV-positive donor hearts at 1 year (16.9% vs 8.2%; P<.001), 5 years (41.8% vs 18.5%; P<.001), and 10 years (50.6% vs 24.3%; P<.001). Using Kaplan-Meier methods, 1-, 5-, and 10-year survival rates were 83%, 53%, and 25%, and 92%, 77%, and 53% for recipients of HCV-positive and HCV-negative donor hearts, respectively (P<.001, log-rank test). Recipients of HCV-positive donor hearts were more likely to die of liver disease and coronary vasculopathy. After propensity matching, the overall hazard ratio (HR) associated with receipt of an HCV-positive donor heart was 2.10 (95% confidence interval [CI], 1.60-2.75). Stratified analyses showed that HRs did not vary by recipient HCV status or by recipient age (for recipients aged 18-39 years: HR, 1.75 [95% CI, 0.70-4.40]; for recipients aged 40-59 years: HR, 2.23 [95% CI, 1.42-3.52]; and for recipients aged 60 years and older: HR, 2.07 [95% CI, 1.32-3.27]; overall P value for interaction, >.10).
  
  
  CONCLUSIONS
  Receipt of a heart from an HCV-positive donor is associated with decreased survival in heart transplant recipients. This association appears to be independent of recipient HCV status and age. Preferential allocation of HCV-positive donors to HCV-positive recipients and/or older recipients is not warranted.
authors.affiliation: Division of Infectious Diseases of the Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia 19104, USA. leanne.gasink@uphs.upenn.edu
authors.forename: Leanne B
authors.initials: LB
authors.lastname: Gasink
authors.forename: Emily A
authors.initials: EA
authors.lastname: Blumberg
authors.forename: A Russell
authors.initials: AR
authors.lastname: Localio
authors.forename: Shashank S
authors.initials: SS
authors.lastname: Desai
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Israni
authors.forename: Ebbing
authors.initials: E
authors.lastname: Lautenbach
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005260:Female; D016027:Heart Transplantation / Q000401:mortality*; D016174:Hepacivirus / Q000302:isolation & purification*; D006526:Hepatitis C; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D016019:Survival Analysis; D014019:Tissue Donors; D014481:United States