Donor hepatitis-C seropositivity is an independent risk factor for the development of accelerated coronary vasculopathy and predicts outcome after cardiac transplantation

Showkat Haji, Randall C. Starling, Robin K. Avery, Steven Mawhorter, E. Murat Tuzcu, Paul Schoenhagen, Daniel J. Cook, Norman B. Ratliff, Patrick M. McCarthy, James B. Young, Mohamad H. Yamani

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Abstract

Background It is possible, but unproven, that hepatitis C (HCV) infection accelerates atherosclerosis. We evaluated the hypothesis that donor HCV seropositivity predicts mortality and the development of coronary vasculopathy in cardiac transplant recipients. Methods Thirty-four cardiac transplant recipients who were seronegative for HCV at the time of transplantation received hearts from HCV-seropositive donors. We compared the mortality and the incidence of vasculopathy in this group of patients (study group) with a group of 183 successive heart transplant recipients (control group) with no evidence of HCV in the donor or in the recipient. Results After transplantation, 75% of the HCV-seronegative patients who received hearts from HCV-seropositive donors had detectable and persistent viremia (presence of HCV-RNA by reverse-transcription polymerase chain reaction). After a mean follow-up of 4.2 ± 1.9 years, mortality was 2.8-fold greater in the study group than in controls (95% confidence interval [CI], 1.3-5.7; p = 0.006). The risk of having any vasculopathy after a mean follow-up of 3.4 ± 1.6 years and after adjustment for other significant risk factors was 3-fold greater (hazards ratio, 3.08; 95% CI 1.52-6.20; p = 0.001) in the HCV group compared with controls. The risk of developing advanced vasculopathy was much greater in the study group compared with controls (hazard ratio, 9.4; 97% CI, 3.3-26.6; p = < 0.0001). The risk of mortality (p = 0.005) and vasculopathy (p = < 0.0001) was greatest in patients with combined donor HCV seropositivity and the presence of antibodies against donor B cells by flow cytometry. Conclusion We conclude that donor hepatitis-C virus seropositivity is an independent risk factor for increased mortality and for the development of accelerated allograft vasculopathy after cardiac transplantation. These observations may have implications for the use of HCV-positive donors in heart transplant recipients.

Original languageEnglish (US)
Pages (from-to)277-283
Number of pages7
JournalJournal of Heart and Lung Transplantation
Volume23
Issue number3
DOIs
StatePublished - Mar 1 2004

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Heart Transplantation
Hepatitis C
Tissue Donors
Mortality
Confidence Intervals
Safety Management
Control Groups
Viremia
Hepacivirus
Reverse Transcription
Allografts
Atherosclerosis
Flow Cytometry
B-Lymphocytes
Transplantation
RNA
Polymerase Chain Reaction
Transplant Recipients
Antibodies
Incidence

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

Donor hepatitis-C seropositivity is an independent risk factor for the development of accelerated coronary vasculopathy and predicts outcome after cardiac transplantation. / Haji, Showkat; Starling, Randall C.; Avery, Robin K.; Mawhorter, Steven; Tuzcu, E. Murat; Schoenhagen, Paul; Cook, Daniel J.; Ratliff, Norman B.; McCarthy, Patrick M.; Young, James B.; Yamani, Mohamad H.

In: Journal of Heart and Lung Transplantation, Vol. 23, No. 3, 01.03.2004, p. 277-283.

Research output: Contribution to journalArticle

Haji, Showkat ; Starling, Randall C. ; Avery, Robin K. ; Mawhorter, Steven ; Tuzcu, E. Murat ; Schoenhagen, Paul ; Cook, Daniel J. ; Ratliff, Norman B. ; McCarthy, Patrick M. ; Young, James B. ; Yamani, Mohamad H. / Donor hepatitis-C seropositivity is an independent risk factor for the development of accelerated coronary vasculopathy and predicts outcome after cardiac transplantation. In: Journal of Heart and Lung Transplantation. 2004 ; Vol. 23, No. 3. pp. 277-283.
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abstract = "Background It is possible, but unproven, that hepatitis C (HCV) infection accelerates atherosclerosis. We evaluated the hypothesis that donor HCV seropositivity predicts mortality and the development of coronary vasculopathy in cardiac transplant recipients. Methods Thirty-four cardiac transplant recipients who were seronegative for HCV at the time of transplantation received hearts from HCV-seropositive donors. We compared the mortality and the incidence of vasculopathy in this group of patients (study group) with a group of 183 successive heart transplant recipients (control group) with no evidence of HCV in the donor or in the recipient. Results After transplantation, 75{\%} of the HCV-seronegative patients who received hearts from HCV-seropositive donors had detectable and persistent viremia (presence of HCV-RNA by reverse-transcription polymerase chain reaction). After a mean follow-up of 4.2 ± 1.9 years, mortality was 2.8-fold greater in the study group than in controls (95{\%} confidence interval [CI], 1.3-5.7; p = 0.006). The risk of having any vasculopathy after a mean follow-up of 3.4 ± 1.6 years and after adjustment for other significant risk factors was 3-fold greater (hazards ratio, 3.08; 95{\%} CI 1.52-6.20; p = 0.001) in the HCV group compared with controls. The risk of developing advanced vasculopathy was much greater in the study group compared with controls (hazard ratio, 9.4; 97{\%} CI, 3.3-26.6; p = < 0.0001). The risk of mortality (p = 0.005) and vasculopathy (p = < 0.0001) was greatest in patients with combined donor HCV seropositivity and the presence of antibodies against donor B cells by flow cytometry. Conclusion We conclude that donor hepatitis-C virus seropositivity is an independent risk factor for increased mortality and for the development of accelerated allograft vasculopathy after cardiac transplantation. These observations may have implications for the use of HCV-positive donors in heart transplant recipients.",
author = "Showkat Haji and Starling, {Randall C.} and Avery, {Robin K.} and Steven Mawhorter and Tuzcu, {E. Murat} and Paul Schoenhagen and Cook, {Daniel J.} and Ratliff, {Norman B.} and McCarthy, {Patrick M.} and Young, {James B.} and Yamani, {Mohamad H.}",
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T1 - Donor hepatitis-C seropositivity is an independent risk factor for the development of accelerated coronary vasculopathy and predicts outcome after cardiac transplantation

AU - Haji, Showkat

AU - Starling, Randall C.

AU - Avery, Robin K.

AU - Mawhorter, Steven

AU - Tuzcu, E. Murat

AU - Schoenhagen, Paul

AU - Cook, Daniel J.

AU - Ratliff, Norman B.

AU - McCarthy, Patrick M.

AU - Young, James B.

AU - Yamani, Mohamad H.

PY - 2004/3/1

Y1 - 2004/3/1

N2 - Background It is possible, but unproven, that hepatitis C (HCV) infection accelerates atherosclerosis. We evaluated the hypothesis that donor HCV seropositivity predicts mortality and the development of coronary vasculopathy in cardiac transplant recipients. Methods Thirty-four cardiac transplant recipients who were seronegative for HCV at the time of transplantation received hearts from HCV-seropositive donors. We compared the mortality and the incidence of vasculopathy in this group of patients (study group) with a group of 183 successive heart transplant recipients (control group) with no evidence of HCV in the donor or in the recipient. Results After transplantation, 75% of the HCV-seronegative patients who received hearts from HCV-seropositive donors had detectable and persistent viremia (presence of HCV-RNA by reverse-transcription polymerase chain reaction). After a mean follow-up of 4.2 ± 1.9 years, mortality was 2.8-fold greater in the study group than in controls (95% confidence interval [CI], 1.3-5.7; p = 0.006). The risk of having any vasculopathy after a mean follow-up of 3.4 ± 1.6 years and after adjustment for other significant risk factors was 3-fold greater (hazards ratio, 3.08; 95% CI 1.52-6.20; p = 0.001) in the HCV group compared with controls. The risk of developing advanced vasculopathy was much greater in the study group compared with controls (hazard ratio, 9.4; 97% CI, 3.3-26.6; p = < 0.0001). The risk of mortality (p = 0.005) and vasculopathy (p = < 0.0001) was greatest in patients with combined donor HCV seropositivity and the presence of antibodies against donor B cells by flow cytometry. Conclusion We conclude that donor hepatitis-C virus seropositivity is an independent risk factor for increased mortality and for the development of accelerated allograft vasculopathy after cardiac transplantation. These observations may have implications for the use of HCV-positive donors in heart transplant recipients.

AB - Background It is possible, but unproven, that hepatitis C (HCV) infection accelerates atherosclerosis. We evaluated the hypothesis that donor HCV seropositivity predicts mortality and the development of coronary vasculopathy in cardiac transplant recipients. Methods Thirty-four cardiac transplant recipients who were seronegative for HCV at the time of transplantation received hearts from HCV-seropositive donors. We compared the mortality and the incidence of vasculopathy in this group of patients (study group) with a group of 183 successive heart transplant recipients (control group) with no evidence of HCV in the donor or in the recipient. Results After transplantation, 75% of the HCV-seronegative patients who received hearts from HCV-seropositive donors had detectable and persistent viremia (presence of HCV-RNA by reverse-transcription polymerase chain reaction). After a mean follow-up of 4.2 ± 1.9 years, mortality was 2.8-fold greater in the study group than in controls (95% confidence interval [CI], 1.3-5.7; p = 0.006). The risk of having any vasculopathy after a mean follow-up of 3.4 ± 1.6 years and after adjustment for other significant risk factors was 3-fold greater (hazards ratio, 3.08; 95% CI 1.52-6.20; p = 0.001) in the HCV group compared with controls. The risk of developing advanced vasculopathy was much greater in the study group compared with controls (hazard ratio, 9.4; 97% CI, 3.3-26.6; p = < 0.0001). The risk of mortality (p = 0.005) and vasculopathy (p = < 0.0001) was greatest in patients with combined donor HCV seropositivity and the presence of antibodies against donor B cells by flow cytometry. Conclusion We conclude that donor hepatitis-C virus seropositivity is an independent risk factor for increased mortality and for the development of accelerated allograft vasculopathy after cardiac transplantation. These observations may have implications for the use of HCV-positive donors in heart transplant recipients.

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