Cardiac allograft vasculopathy in heart transplant recipients from hepatitis C viremic donors

• Published in: Clinical transplantation Vol. 38; no. 4; pp. e15294 - n/a
• Main Authors: Kadosh, Bernard S., Birs, Antoinette S., Flattery, Erin, Stachel, Maxine, Hong, Kimberly N., Xia, Yuhe, Gidea, Claudia, Aslam, Saima, Razzouk, Louai, Saraon, Tajinderpal, Goldberg, Randal, Rao, Shaline, Pretorius, Victor, Moazami, Nader, Smith, Deane E., Adler, Eric D., Reyentovich, Alex
• Format: Journal Article
• Language: English
• Published: Denmark 01.04.2024
• Subjects: Allografts; cardiovascular disease; donors and donation: donorderived infections; Female; Follow-Up Studies; Heart Transplantation - adverse effects; Hepacivirus; Hepatitis C - etiology; Humans; infection and infectious agents; Male; Middle Aged; Retrospective Studies; Tissue Donors; Transplant Recipients; vasculopathy; viral: hepatitis C; Viremia - epidemiology; Viremia - etiology; cardiovascular disease; infection and infectious agents; vasculopathy; donors and donation: donorderived infections; viral: hepatitis C
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.15294

Background Recent studies suggest the transplantation of Hepatitis C (HCV) hearts from viremic donors is associated with comparable 1 year survival to nonviremic donors. Though HCV viremia is a known risk factor for accelerated atherosclerosis, data on cardiac allograft vasculopathy (CAV) outcomes are limited. We compared the incidence of CAV in heart transplant recipients from HCV viremic donors (nucleic acid amplification test positive; NAT+) compared to non‐HCV infected donors (NAT−). Methods We retrospectively reviewed annual coronary angiograms with intravascular ultrasound from April 2017 to August 2020 at two large cardiac transplant centers. CAV was graded according to ISHLT guidelines. Maximal intimal thickness (MIT) ≥ 0.5 mm was considered significant for subclinical disease. Results Among 270 heart transplant recipients (mean age 54; 77% male), 62 patients were transplanted from NAT+ donors. CAV ≥ grade 1 was present in 8.8% of the NAT+ versus 16.8% of the NAT‐ group at 1 year, 20% versus 28.8% at 2 years, and 33.3% versus 41.5% at 3 years. After adjusting for donor age, donor smoking history, recipient BMI, recipient, hypertension, and recipient diabetes, NAT+ status did not confer increased risk of CAV (HR.80; 95% CI.45–1.40, p = 0.43) or subclinical IVUS disease (HR.87; 95% CI.58–1.30, p = 0.49). Additionally, there was no difference in the presence of rapidly progressive lesions on IVUS. Conclusion Our data show that NAT+ donors conferred no increased risk for early CAV or subclinical IVUS disease following transplantation in a cohort of heart transplant patients who were treated for HCV, suggesting the short‐term safety of this strategy to maximize the pool of available donor hearts.