Early outcomes in patients undergoing heart re-transplantation in the era of HCV-viremic donors.

Background: The use of hepatitis C virus (HCV) viremic donors has increased the heart donor pool and reduced waitlist time and mortality among first-time single-organ heart transplant (HT) candidates without compromising their post-transplant survival. The outcomes of heart re-transplantation (re-HT) using HCV-viremic donor grafts have not been investigated.

Methods: Using the United Network for Organ Sharing Registry, we analyzed adult patients who underwent re-HT in the USA between January 1, 2016, and December 31, 2023. HCV-viremic donors were defined by a positive nucleic acid amplification test.

Results: Of 25,836 HTs performed, 509 (2 %) were single-organ re-HT: 21 and 488 from HCV-viremic and nonviremic donors, respectively. Among the two recipient groups, there were no significant differences in age, body mass index, blood type, diabetes or stroke rates, creatinine or bilirubin levels, time from the first HT, hemodynamics, use of inotropic/mechanical circulatory support, listing status, and waitlist time. Ischemic time, cytomegalovirus, donor/recipient gender mismatch rates, and calculated panel reactive antibodies levels were comparable across the two groups. There were no significant differences in demographics or comorbidities between HCV-viremic and HCV-nonviremic donors. At 1 year post-re-HT, rates of acute rejection and cardiac allograft vasculopathy were comparable across the two groups. Short-term survival rates were similar at 30 days (95.2 % vs. 91.8 %), 1 year (95.2 % vs. 84.4 %), and 2 years (95.2 % vs. 80.7 %) for recipients of HCV-viremic and nonviremic donor grafts, respectively (p = 0.3).

Conclusion: This study provides preliminary evidence that short-term post-re-HT outcomes of recipients of HCV-viremic donor grafts are comparable to those of recipients of HCV-nonviremic donor grafts.