Heart Transplant Outcomes in Patients Who Receive Hepatitis B Virus (HBV) Positive Donor Hearts
P A Genyk 1 , G S Liu 1 , J Nattiv 1 , P Banankhah 1 , J P Li 1 , P A Kingsford 1 , A Wolfson 2 , D Vucicevic 3 , A S Vaidya 1 , E C DePasquale 1
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PMID: 32464969 DOI: 10.1016/j.healun.2020.01.1128
Abstract
Purpose: The advent of anti-viral therapy for HBV has made it possible to expand the donor pool for heart transplant recipients. Little is known in long term outcomes of recipients who receive HBV+ donor hearts. We sought to explore long-term transplant outcomes in recipients who received HBV+ donor hearts compared to those who received HBV- donor hearts.
Methods: UNOS registry was queried and identified 1,141 patients who received a heart transplant from hepatitis B core antibody (HBcAb)+ donors and 53,192 patients who received a heart transplant from HBcAb- donors. Multivariate Cox proportional hazard regression analysis was adjusted for age, sex, diabetes, ethnicity, ischemic time, dialysis, life support, waitlist time and HLA mismatch. Kaplan-Meier survival curves were generated comparing survival outcomes in patients post-HT with HBcAb+ donor to patients post-HT with HBcAb- donor.
Results: There were 1141 patients in the donor HBV+ cohort and 53,192 patients in the donor HBV- cohort. HBV+ cohort were younger (p<0.001) but just as likely to have diabetes, be on dialysis, and have similar smoking status compared to HBV- cohort. Patients required similar amounts of support, including VAD and mechanical ventilation, except for greater frequency of IABP in the HBV+ cohort (p=0.004). Ischemic time was increased in the HBV+ cohort (p<0.001). No difference in waitlist time was observed between cohorts. Overall survival in the HBV- donor cohort at 1, 5 and 10 years post-HT was 88, 74, and 57%, respectively; in the HBV+ donor cohort, survival at 1, 5 and 10 years post-HT was 85, 71, and 52%, respectively (Figure, log rank p=0.0001).
Conclusion: Use of HBV+ donors in heart transplantation was associated with worse overall survival compared to use of HBV- donors. Further study is warranted to better understand the implications of these findings.
接受乙型肝炎病毒（HBV）阳性供体心脏的患者的心脏移植结果
P A Genyk 1，G S Liu 1，J Nattiv 1，P Banankhah 1，J P Li 1，P A Kingsford 1，A Wolfson 2，D Vucicevic 3，A S Vaidya 1，E C DePasquale 1
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