Impact of hepatitis C infection on outcomes after heart transplantation.
BACKGROUND
Prevalence of hepatitis C infection (HCV) among heart transplant (OHT) recipients ranges from 7% to 18%. Despite the paucity of data regarding the outcomes of heart transplant recipients who are HCV positive before transplant, many transplant centers are declining to perform OHT in HCV-seropositive patients.


METHODS
We assessed the clinical outcome of HCV-seropositive compared with HCV-seronegative heart transplant recipients using the Organ Procurement and Transplant Network/the United Network for Organ Sharing database. Between January 1, 2000, and December 31, 2005, 224 HCV-seropositive and 10,406 HCV-seronegative recipients who received HCV-seronegative donor organs were identified.


RESULTS
Overall patient survival rates of HCV-seropositive recipients were significantly lower than those of HCV-seronegative recipients (84.8% at 1 year, 77.1% 3 years, 68.9% 5 years for HCV-seropositive group vs. 87.9% at 1 year, 80.7% 3 years, and 74.1% 5 years for HCV-negative recipients, log rank P=0.036). However, adjusted relative risk of recipient HCV-seropositive versus HCV-seronegative status did not reach to statistical significance level (relative risk=1.23 with P=0.087) after adjusting for other donor and recipient factors. Causes of death among HCV-seropositive and HCV-seronegative groups were similar. Cumulative incidence of an acute rejection episode in the first year after transplantation among HCV-seropositive recipients was 35.7% versus 32.6% HCV-seronegative recipients (P=0.32).


CONCLUSIONS
A more rational approach should be developed for the management of HCV-seropositive heart transplant candidates. Carefully selected HCV-seropositive patients should not be excluded from OHT.
Fong
Tse-Ling
TL
Abdominal Transplantation Program, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. tselingf@usc.edu
Hou
Linda
L
Hutchinson
Ian V
IV
Cicciarelli
James C
JC
Cho
Yong W
YW
D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000453:epidemiology; D006084:Graft Rejection / Q000453:epidemiology; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality / Q000502:physiology; D006526:Hepatitis C / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D011183:Postoperative Complications / Q000453:epidemiology; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D003404:Creatinine