Early Assessment of Cardiac Allograft Vasculopathy Risk Among Recipients of Hepatitis C Virus-infected Donors in the Current Era

• DOI: 10.1016/j.cardfail.2023.09.015
• Publication Date: 2023-10-29T23:08:56Z
• Authors: KAUSHIK AMANCHERLA; IRENE D. FEURER; SCOTT A. REGA; ANDREW CLUCKEY; MOHAMED SALIH; JONATHAN DAVIS; DAWN PEDROTTY; HENRY OOI; ANIKET S. RALI; HASAN K. SIDDIQI; JONATHAN MENACHEM; DOUGLAS M. BRINKLEY; LYNN PUNNOOSE; SUZANNE B. SACKS; SANDIP K. ZALAWADIYA; MARK WIGGER; KEKI BALSARA; JOHN TRAHANAS; WILLIAM G. MCMASTER; JORDAN HOFFMAN; CHETAN PASRIJA; JOANN LINDENFELD; ASHISH S. SHAH; KELLY H. SCHLENDORF
• Keywords: Cardiac allograft vasculopathy

Transplantation of hearts from hepatitis C virus (HCV)-positive donors has increased substantially in recent years following development of highly effective direct-acting antiviral therapies for treatment and cure of HCV. Although historical data from the pre-direct-acting antiviral era demonstrated an association between HCV-positive donors and accelerated cardiac allograft vasculopathy (CAV) in recipients, the relationship between the use of HCV nucleic acid test-positive (NAT+) donors and the development of CAV in the direct-acting antiviral era remains unclear.We performed a retrospective, single-center observational study comparing coronary angiographic CAV outcomes during the first year after transplant in 84 heart transplant recipients of HCV NAT+ donors and 231 recipients of HCV NAT- donors. Additionally, in a subsample of 149 patients (including 55 in the NAT+ cohort and 94 in the NAT- cohort) who had serial adjunctive intravascular ultrasound examination performed, we compared development of rapidly progressive CAV, defined as an increase in maximal intimal thickening of ≥0.5 mm in matched vessel segments during the first year post-transplant. In an unadjusted analysis, recipients of HCV NAT+ hearts had reduced survival free of CAV ≥1 over the first year after heart transplant compared with recipients of HCV NAT- hearts. After adjustment for known CAV risk factors, however, there was no significant difference between cohorts in the likelihood of the primary outcome, nor was there a difference in development of rapidly progressive CAV.These findings support larger, longer-term follow-up studies to better elucidate CAV outcomes in recipients of HCV NAT+ hearts and to inform post-transplant management strategies.