title: Effect of Hepatitis C Positivity on Survival in Adult Patients Undergoing Heart Transplantation (from the United Network for Organ Sharing Database).
abstract: Concerns exist regarding orthotropic heart transplantation in hepatitis C virus (HCV) seropositive recipients. Thus, a national registry was accessed to evaluate early and late outcome in HCV seropositive recipients undergoing heart transplant. Retrospective analysis of the United Network for Organ Sharing registry (1991 to 2014) was performed to evaluate recipient profile and clinical outcome of patients with HCV seropositive (HCV +ve) and seronegative (HCV -ve). Adjusted results of early mortality and late survival were compared between cohorts. From 23,507 patients (mean age 52 years; 75% men), 481 (2%) were HCV +ve (mean age 52 years; 77% men). Annual proportion of HCV +ve recipients was comparable over the study period (range 1.3% to 2.7%; p = 0.2). The HCV +ve cohort had more African-American (22% vs 17%; p = 0.01), previous left ventricular assist device utilization (21% vs 14%; p <0.01) and more hepatitis B core Ag+ve recipients (17% vs 5%; p <0.01). However, both cohorts were comparable in terms of extracorporeal membrane oxygenator usage (p = 0.7), inotropic support (p = 0.2), intraaortic balloon pump (p = 0.7) support, serum creatinine (p = 0.7), and serum bilirubin (p = 0.7). Proportion of status 1A patients was similar (24% HCV + vs 21% HCV -); however, wait time for HCV +ve recipients were longer (mean 23 vs 19 days; p <0.01). Among donor variables, age (p = 0.8), hepatitis B status (p = 0.4), and Center for Diseases Control high-risk status (p = 0.9) were comparable in both cohorts. At a median follow-up of 4 years, 67% patients were alive, 28% died, and 1.1% were retransplanted (3.4% missing). Overall survival was worse in the HCV+ cohort (64.3% vs 72.9% and 43.2% vs 55% at 5 and 10 years; p <0.01), respectively. Late renal (odds ratio [OR] 1.2 [1 to 1.6]; p = 0.02) and liver dysfunction (odds ratio 4.5 [1.2 to 15.7]; p = 0.01) occurs more frequently in HCV +ve recipients. On adjusted analysis, HCV seropositivity is associated with poorer survival (hazard ratio for mortality 1.4 [1.1 to 1.6]; p <0.001). In conclusion, a small proportion of patients receiving a heart transplant in the United States have hepatitis C. Despite comparable preoperative hepatic function, hepatitis C seropositive recipients demonstrate poorer long-term survival.
authors.affiliation: Division of Cardiovascular Surgery, Advanced Heart Failure Program, University of Texas Medical Center, Houston, Texas.
authors.forename: Sachin
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio. Electronic address: svd14@case.edu.
authors.forename: Salil V
authors.initials: SV
authors.lastname: Deo
authors.affiliation: Department of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan.
authors.forename: Salah E
authors.initials: SE
authors.lastname: Altarabsheh
authors.affiliation: Department of Cardiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Dunlay
authors.affiliation: Division of Nephrology and Renal Transplantation, University Hospitals, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Nagaraju
authors.initials: N
authors.lastname: Sarabu
authors.affiliation: Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Basar
authors.initials: B
authors.lastname: Sareyyupoglu
authors.affiliation: Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Yakov
authors.initials: Y
authors.lastname: Elgudin
authors.affiliation: Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Medalion
authors.affiliation: Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Chantal
authors.initials: C
authors.lastname: ElAmm
authors.affiliation: Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Mahazarin
authors.initials: M
authors.lastname: Ginwalla
authors.affiliation: Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Michael
authors.initials: M
authors.lastname: Zacharias
authors.affiliation: Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Rodolpho
authors.initials: R
authors.lastname: Benatti
authors.affiliation: Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Guilherme H
authors.initials: GH
authors.lastname: Oliveira
authors.affiliation: Division of Cardiothoracic Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Kilic
authors.affiliation: Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, Los Angeles, California.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Divisions of Cardiovascular Surgery and Cardiology, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Soon J
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000328:Adult; D005260:Female; D006085:Graft Survival; D006333:Heart Failure / Q000401:mortality* / Q000601:surgery* / Q000821:virology; D016027:Heart Transplantation; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States