Long-term outcomes of heart transplant recipients with hepatitis C positivity: the data from the US transplant registry

Background: Chronic HCV infection is often considered a contraindication for receiving a heart transplantation. Methods: 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. Results: 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). Conclusion: 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.