title: Long-term outcomes of heart transplant recipients with hepatitis C positivity: the data from the U.S. transplant registry.
abstract: Chronic HCV infection is often considered a contraindication for receiving a heart transplantation.
  
  
  
  From the Scientific Registry of Transplant Recipients, we selected all adults with and without HCV infection who underwent a single-organ heart transplantation in 1995-2013; the mortality status was updated in September 2015.
  
  
  
  A total of 32 812 heart transplant recipients were included; N=756 (2.30%) HCV positive. Post-transplant patients were discharged alive at similar rates regardless of their HCV status (P=.10). Despite this, mortality in HCV+ heart transplant recipients was consistently higher throughout post-discharge follow-up (P<.002). In multivariate survival analysis, being HCV+ was independently associated with a higher post-transplant mortality: adjusted hazard ratio 1.35 (1.16-1.56), P<.0001. Other predictors of lower post-transplant survival included being obese at transplant and pre-transplant history of comorbidities (type 2 diabetes, COPD, hypertension) (all P<.05). No association of HCV infection with graft loss rates or time to graft loss was found (all P>.23).
  
  
  
  Chronic hepatitis C infection is associated with a significantly increased post-transplant mortality in heart transplant recipients. The introduction of new direct-acting antiviral agents may provide a treatment option for HCV pre- or post-heart transplantation which could have a positive impact on patients' survival.
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.|Center for Outcomes Research in Liver Diseases, Washington, DC, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Stepanova
authors.affiliation: Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA.
authors.forename: Trevor
authors.initials: T
authors.lastname: Locklear
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.|Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA.
authors.forename: Nila
authors.initials: N
authors.lastname: Rafiq
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.|Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA.
authors.forename: Alita
authors.initials: A
authors.lastname: Mishra
authors.affiliation: Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA.
authors.forename: Chapy
authors.initials: C
authors.lastname: Venkatesan
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.|Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA.
authors.forename: Zobair M
authors.initials: ZM
authors.lastname: Younossi
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality*; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States
keywords: SRTR; extended criteria donor; graft loss; heart transplant; hepatitis C; mortality; outcomes