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Local and regional variability in utilization and allocation of hepatitis C virus–infected hearts for transplantation
Author(s) -
Prakash Katya,
Wainana Charles,
Trageser Jeffrey,
Hahn Ashley,
Lay Cecilia,
Pretorius Victor,
Adler Eric,
Aslam Saima
Publication year - 2020
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15857
Subject(s) - medicine , hepatitis c virus , economic shortage , hepatitis c , transplantation , united network for organ sharing , organ procurement , virology , heart transplantation , immunology , liver transplantation , virus , linguistics , philosophy , government (linguistics)
With the advent of direct‐acting antiviral agents, there has been a rapid rise in hepatitis C virus–infected (HCV+) heart transplantation. We aimed to understand local and regional differences in utilization and allocation of HCV+ hearts. Using United Network for Organ Sharing (UNOS) de‐identified data from January 1, 2016 to September 30, 2019 we compared trends in the utilization rates (hearts transplanted/donors recovered) of HCV‐uninfected (HCV−) to those of HCV+ nonviremic (HCV‐NV) and viremic (HCV‐V) hearts nationally and by UNOS region. We also evaluated allocation rates (hearts successfully allocated/donors recovered) by organ procurement organization (OPO). We found that (1) in 2019, national utilization rates for HCV‐NV and HCV‐V hearts were the same as HCV− hearts (27.6% for HCV‐NV, 30.9 for HCV‐V, and 31.7% for HCV−, P = .277); (2) utilization rates of HCV‐NV hearts were low in regions 3 and 4 and of HCV‐V hearts in regions 3, 4, and 8 even in the contemporary period since 2018; and (3) there was marked variability in allocation of HCV+ hearts at the OPO level even within the same UNOS region. We conclude that despite national strides in the utilization of HCV+ hearts for transplantation, more aggressive allocation of HCV+ hearts at the OPO level may still significantly affect the organ shortage.