Long-Term Outcomes of Heart Transplantation Using Hepatitis C-Positive Donors.

BACKGROUND: The global shortage of donor organs has prompted the utilization of extended criteria donors, including those infected with hepatitis C virus (HCV). While direct-acting antivirals (DAAs) have made this strategy feasible, data regarding long-term outcomes in the Asian population remain limited. We aimed to evaluate the long-term survival outcomes of heart transplantation (HT) using HCV-positive donors in a single-center Asian cohort. METHODS: This retrospective study analyzed 451 adult HT recipients at a single center in Taiwan between July 1, 1988, and June 30, 2024. Patients were stratified into HCV-positive donor (n = 20) and HCV-negative donor (n = 431) groups. Propensity score overlap weighting (OW) was employed to balance baseline characteristics. The primary endpoint was long-term all-cause mortality. RESULTS: The median follow-up duration was 10.5 years. All recipients of HCV-positive hearts who developed viremia achieved a sustained virologic response (SVR12) with DAA therapy, resulting in a final cure rate of 100%. Kaplan-Meier analysis revealed no significant difference in long-term survival between the 2 groups (log-rank P = .136). In the overlap-weighted Cox proportional hazards model, donor HCV status was not an independent predictor of 10-year mortality (adjusted hazard ratio [HR] 1.88; 95% confidence interval [CI] 0.50-7.05; P = .350). CONCLUSIONS: HT using HCV-positive donors is a viable strategy in the Asian population, yielding long-term survival comparable to that of HCV-negative donors. With the availability of effective DAA therapy, this approach can be successfully implemented to expand the donor pool without compromising recipient outcomes.