title: Decreased post-transplant survival among heart transplant recipients with pre-transplant hepatitis C virus positivity.
abstract: BACKGROUND
  Transplant centers are reluctant to perform heart transplantation in patients with hepatitis C virus (HCV) infection because augmented immunosuppression could potentially increase mortality. However, there have been few studies examining whether HCV infection reduces survival after heart transplantation.
  
  
  METHODS
  We used data from the the U.S. Scientific Registry of Transplant Recipients to perform a multicenter cohort study evaluating the association between recipient pre-transplant HCV status and survival after heart transplantation. Adults undergoing heart transplantation between January 1, 1993 and December 31, 2007 were eligible to participate.
  
  
  RESULTS
  Among 20,687 heart transplant recipients (443 HCV-positive and 20,244 HCV-negative) at 103 institutions followed for a mean of 5.6 years, mortality was higher among HCV-positive than HCV-negative recipients (177 [40%] vs 6,367 [31.5%]; p = 0.0001). After matching on propensity score, hospital and gender, the hazard ratio (HR) of death for HCV-positive heart transplant recipients was 1.32 (95% confidence interval [CI] 1.08 to 1.61). Mortality rates were higher among HCV-positive heart transplant recipients at 1 year (9.4% vs 8.2%), 5 years (26.3% vs 22.9%), 10 years (53.1% vs 43.4%) and 15 years (74.8% vs 62.3%) post-transplantation. HRs did not vary by gender or overall number of heart transplantations performed at the center.
  
  
  CONCLUSIONS
  Pre-transplant HCV positivity is associated with decreased survival after heart transplantation.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. ingi.lee@uphs.upenn.edu
authors.forename: Ingi
authors.initials: I
authors.lastname: Lee
authors.forename: Russell
authors.initials: R
authors.lastname: Localio
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Brensinger
authors.forename: Emily A
authors.initials: EA
authors.lastname: Blumberg
authors.forename: Ebbing
authors.initials: E
authors.lastname: Lautenbach
authors.forename: Leanne
authors.initials: L
authors.lastname: Gasink
authors.forename: Valerianna K
authors.initials: VK
authors.lastname: Amorosa
authors.forename: Vincent
authors.initials: V
authors.lastname: Lo Re
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality*; D016174:Hepacivirus / Q000276:immunology*; D006526:Hepatitis C / Q000150:complications / Q000401:mortality* / Q000821:virology; D018937:Hepatitis C Antibodies / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
chemical_list: D018937:Hepatitis C Antibodies