Background

Transplanting organs from hepatitis c virus (HCV) infected donors into HCV-negative recipients has led to thousands of more transplants in the US since 2016. Studies have demonstrated disparities in utilization of kidneys from these donors due to gender and education. It is still unknown, however, if the same disparities are seen in heart and lung transplantation.

Methods

We used Organ Procurement and Transplantation (OPTN)/United Network for Organ Sharing (UNOS) data on all isolated heart and lung transplants from 11/01/2018- 03/31/2023, classifying donors based on their HCV nucleic acid test (NAT) result: HCV NAT- vs HCV NAT+. We fit separate mixed effects logistic regression models (outcome: HCV-NAT+ donor) for heart and lung transplants. Primary covariates included: 1) race/ethnicity; 2) sex; 3) education level; 4) insurance type; and 5) transplant year.

Results

The study included 26,108 adults (14,189 isolated heart transplant recipients and 11,919 isolated lung transplant recipients). 993 (7.0%) heart transplants involved an HCV-NAT+ donor, compared to 457 (3.8%) lung transplants. In multivariable models among all isolated heart transplant recipients, women were significantly less likely to receive an HCV-NAT+ donor heart (OR: 0.79, 95% CI: 0.67-0.92, P=0.003), as were Asian patients (OR: 0.52, 95% CI: 0.31=0.86, P= 0.01). In multivariable models among all isolated lung transplant recipients, Asians were significantly less likely to receive HCV-NAT+ transplants (OR: 0.31, 95% CI: 0.12-0.77, P= 0.01).

Conclusion

There are disparities in utilization of heart and lungs from HCV NAT+ donors, with women and Asian patients being significantly less likely to receive these transplants.

中文翻译：

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丙型肝炎心肺移植中的种族和性别差异

背景

自 2016 年以来，将感染丙型肝炎病毒 (HCV) 的捐献者的器官移植到 HCV 阴性受者体内的做法已导致美国进行了数千例移植手术。研究表明，由于性别和教育程度的原因，这些捐献者的肾脏利用率存在差异。然而，尚不清楚心脏和肺移植是否也存在同样的差异。

方法

我们使用了器官获取和移植 (OPTN)/联合器官共享网络 (UNOS) 2018 年 1 月 11 日至 2023 年 3 月 31 日期间所有离体心脏和肺移植的数据，根据捐赠者的 HCV 核酸检测 (NAT) 对捐赠者进行分类) 结果：HCV NAT- 与 HCV NAT+。我们针对心脏和肺移植拟合单独的混合效应逻辑回归模型（结果：HCV-NAT+供体）。主要协变量包括：1）种族/民族；2）性别；3）教育程度；4）保险类型；5) 移植年份。

结果

该研究包括 26,108 名成年人（14,189 名离体心脏移植接受者和 11,919 名离体肺移植接受者）。993 例 (7.0%) 心脏移植涉及 HCV-NAT+ 供体，而肺移植为 457 例 (3.8%)。在所有离体心脏移植受者的多变量模型中，女性接受 HCV-NAT+ 供体心脏的可能性明显较低（OR：0.79，95% CI：0.67-0.92，P=0.003），亚洲患者也是如此（OR：0.52， 95% CI：0.31=0.86，P=0.01）。在所有离体肺移植受者的多变量模型中，亚洲人接受 HCV-NAT+ 移植的可能性明显较低（OR：0.31，95% CI：0.12-0.77，P = 0.01）。

结论

HCV NAT+ 捐赠者的心脏和肺的利用存在差异，女性和亚洲患者接受这些移植的可能性明显较低。