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OCTOBER 20, 2006
  Hearts Transplanted from Hepatitis C Donors Associated with Lower Survival Rates in Recipients, Penn Study Finds
  Liberalization of Donor Criteria Cited in Survival Disadvantage
    (Philadelphia, PA) – Researchers at the University of Pennsylvania’s School of Medicine have found that heart transplant patients who receive a donor heart from a person with hepatitis C (HCV) have a lower rate of survival. Corresponding Author Leanne Gasink, MD, MSCE, of the University of Pennsylvania’s Division of Infectious Disease and colleagues report their findings in the October 17th issue of The Journal of the American Medical Association.

Each year between 10% and 20 % of patients awaiting heart transplants expire due to the critical shortage of available cardiac organs. One potential solution formed by the American Heart Association in 2001 to narrow this gap stated HCV-positive donors “may be appropriate in selected higher-risk recipients.” Despite the substantial risk of HCV transmission to the patient and subsequent liver enzyme damage, the effects on patient survival have previously been unclear.

“Some medical experts have advocated the use of HCV-positive cardiac organs because of shortages in suitable donor hearts,” Gasink said. "This approach should be used cautiously as use of HCV-positive donors is associated with decreased survival, even in older recipients."

Dr. Gasink’s study used data from the Scientific Registry of Transplant Recipients. All adult heart transplant recipients from April 1994 to July 2003 were eligible for inclusion. Out of 10,915 patients documented, 261 received an HCV-positive heart.

Using Kaplan-Meier methods, the study found the survival rates lower among HCV-positive recipients compared with HCV-negative recipients at 1 year (83% vs. 92%), 5 years (53% vs. 77%), and 10 years (25% vs. 53%). The rate of death was also higher among recipients of HCV-positive hearts compared to HCV-negative hearts. At 1, 5, and 10 years, death rates for HCV-positive organs were 16.9 %, 41.8%, and 50.6% versus 8.2%, 18.5%, and 24.3 % for HCV-negative cardiac organs. These numbers appear to be independent of recipient age and HCV status. Furthermore, recipients of HCV-positive donor hearts were more likely to die from liver disease and coronary artery disease.

Study co-authors include Emily Blumberg and Ebbing Lautenbach from the Division of Infectious Disease at Penn; A. Russell Localio from the Department of Biostatics and Epidemiology at Penn; Shashank Desai from the Heart Failure and Transplant Program at Inova Fairfax Hospital; and Ajay Israni from the Hennepin County Medical Center.

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