Heart From Donor With Hepatitis C Reduces Survival

Study dashes hopes that these organs might be of wider use

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By Ed Edelson
HealthDay Reporter

TUESDAY, Oct. 17, 2006 (HealthDay News) -- Heart transplant recipients whose organ comes from a donor infected with the hepatitis C virus have a much lower survival rate than those whose donors are free of the virus, a new study finds.

There has been ongoing debate about transplanting hearts from donors infected with the common virus, which attacks the liver. Doctors who favored the use of these hearts to help counter the persistent shortage of donor hearts have argued that hepatitis C-positive organs could be used for older people, or for patients already infected with the virus.

However, "The important thing about this paper is that being older or already positive for hepatitis C does not negate the adverse effect" of receiving an infected organ, said study lead author Dr. Leanne B. Gasink, an instructor at the University of Pennsylvania School of Medicine's department of infectious diseases, in Philadelphia.

Her team published its findings in the Oct. 18 Journal of the American Medical Association.

Experts estimate that about 3 million people in the United States are infected with the hepatitis C virus. This multicenter study may put an end to the hope that hepatitis C-positive hearts might still be useful for some transplant recipients, Gasink said.

In their study, her team analyzed nationwide data on nearly 11,000 people who had heart transplants between 1994 and 2003, including 261 hearts from donors who tested positive for hepatitis C.

The death rate for those recipients of virus-tainted organs was higher from the start: 16.9 percent after one year, compared to 8.2 percent of those getting healthier organs. This two-fold difference in survival persisted over a decade: 25 percent of those who got a hepatitis C-infected heart remained alive after 10 years, compared to 53 percent of those getting virus-free hearts.

"This exactly confirms my original observation, which was to express extreme caution with hepatitis-C donors," said Dr. Daniel Marelli, associate professor of surgery at the University of California, Los Angeles. He was the lead author of a 2002 study of a much smaller number of transplant recipients that also showed a survival gap.

"What [Gasink's team] confirmed is that the hepatitis C virus predisposes recipients to graft coronary disease," Marelli said.

Graft coronary disease occurs when donated organs are overwhelmed by multiple blood vessel blockages. The condition remains mysterious and is currently "one of the most intense areas of research," Marelli said. Hepatitis C viral infection appears to be one cause of graft coronary disease, he said.

Marelli was impressed by the large number of cases in the study, but Dr. Robert H. Rubin, co-chair of the department of infectious diseases at Brigham and Women's Hospital in Boston, called the report "just a good start."

"A larger number of patients would make us all feel better," Rubin said.

The development of some treatment that would curb the adverse effects of hepatitis C might someday make infected hearts viable for recipients, but that day is still far off, he said.

Meanwhile, such a heart might still be transplanted into patients with no other alternative -- someone "on life support with not much time to wait," Rubin said.

The use of those hearts "should be decided on a case-by-case basis," Gasink said. "If the patient's life expectancy is extremely short, the benefits of receiving the heart might outweigh the ill effects."

Marelli agreed. "If someone is desperate, on their deathbed, it might be a justified risk," he said.

More information

There's more on hepatitis C and related viruses at the U.S. National Library of Medicine.

SOURCES: Leanne B. Gasink, M.D., instructor, infectious diseases department, University of Pennsylvania School of Medicine, Philadelphia; Daniel Marelli, M.D., associate professor of surgery, University of California, Los Angeles; Robert H. Rubin, co-chair, department of infectious diseases, Brigham and Women's Hospital, Boston; Oct. 18, 2006, Journal of the American Medical Association

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