More than 185 million people worldwide, including more than 4 million in the U.S., are infected with the hepatitis C virus (HCV).1 Because of the indolent nature of the disease, actual prevalence is underestimated.2,3 Detection of HCV in people already infected is estimated to continue to increase over the next decade.4 Although primary manifestations of the disease are the result of liver damage, HCV infection is a systemic illness. In a study of more than 19,000 patients, HCV infection was identified as an independent risk factor for development of heart failure.5 In the U.S., prevalence of HCV infection in patients with heart failure is reported to be as high as 15%, much higher than the general population prevalence of 1.8%.6 When first identified in 1989, HCV infection was considered incurable. Clinical trials have since found a steady improvement in outcome, and now the disease is considered curable in up to 90% of cases.7
Clinical outcomes of heart transplantation (HTx) historically have been inferior in patients with HCV infection.8,9 The authors hypothesized that the literature on HTx outcomes has not accounted for the improvements in HCV infection treatment options that have occurred since the 1990s. In the study reported here, United Network of Organ Sharing (UNOS) data on adult HTx was used to evaluate clinical outcomes of HCV infection over 4 treatment eras.