Medium-term comprehensive outcomes of heart transplantation using donors with hepatitis C viremia to aviremic recipients.

Background: Although direct-acting antiviral (DAA) therapy has enabled successful use of organs from donors with hepatitis C (HCV) with favorable initial results, medium-term outcome data remains insufficient. This study aimed to compare 4-year mortality, primary graft dysfunction, and major adverse cardiac events (MACE) between heart transplants from donors with hepatitis C viremia (D+) and donors without hepatitis C viremia (D-) in aviremic recipients. Medium-term complications, including incidence of rejection, coronary artery vasculopathy (CAV), fibrosing cholestatic hepatitis (FCH), and extrahepatic manifestations of HCV, were also investigated. Methods: This retrospective cohort study included 256 (23 D+ and 233 D-) heart transplant recipients at a single institution between 2018 and 2022. Results: Over a 4-year follow-up period, survival was similar between D+ and D- recipients (91.3% [21/23] vs 89.3% [208/233], p = 0.61). The likelihood of death from primary graft dysfunction was similar between D+ and D- groups within a 90-day follow-up period (4.3% vs 2.1%, p = 0.52). The rate of composite MACE was similar in both groups (p = 1.00). Both D+ and D- groups had similar rates of acute cellular rejection (8.7% vs 12.9%, p = 0.94), antibody-mediated rejection (4.3% vs 8.2%, p = 1.00), and CAV (17.4% vs 11.6%, p = 0.27). None of the patients developed fibrosing cholestatic hepatitis. No definitive extra-hepatic manifestations of HCV were noted in D+ recipients. Conclusion: Patient and graft survival rates do not differ between D+ and D- heart transplant recipients. There is no difference in post-transplant complications, including MACE, rejection, CAV, FCH, and extrahepatic manifestations of HCV. These findings suggest medium-term safety in utilizing D+ hearts for enlarging the pool of limited organs.