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. 2023 Apr;165(4):1587-1595.e2.
doi: 10.1016/j.jtcvs.2022.08.019. Epub 2022 Sep 7.

Trends in use and three-year outcomes of hepatitis C virus-viremic donor lung transplants for hepatitis C virus-seronegative recipients

Jessica M Ruck  1 , Laura B Zeiser  1 , Alice L Zhou  1 , Alexis P Chidi  1 , Sophia L Winchester  2 , Christine M Durand  3 , Jinny S Ha  1 , Pali D Shah  4 , Allan B Massie  5 , Dorry L Segev  6 , Christian A Merlo  4 , Errol L Bush  7
Affiliations

Trends in use and three-year outcomes of hepatitis C virus-viremic donor lung transplants for hepatitis C virus-seronegative recipients

Jessica M Ruck et al. J Thorac Cardiovasc Surg. 2023 Apr.

Abstract

Objective: The feasibility and 6-month outcome safety of lung transplants (LTs) from hepatitis C virus (HCV)-viremic donors for HCV-seronegative recipients (R-) were established in 2019, but longer-term safety and uptake of this practice nationally remain unknown.

Methods: We identified HCV-seronegative LT recipients (R-) 2015-2020 using the Scientific Registry of Transplant Recipients. We classified donors as seronegative (D-) or viremic (D+). We used χ2 testing, rank-sum testing, and Cox regression to compare posttransplant outcomes between HCV D+/R- and D-/R- LT recipients.

Results: HCV D+/R- LT increased from 2 to 97/year; centers performing HCV D+/R- LT increased from 1 to 25. HCV D+/R- versus HCV D-/R- LT recipients had more obstructive disease (35.7% vs 23.3%, P < .001), lower lung allocation score (36.5 vs 41.1, P < .001), and longer waitlist time (P = .002). HCV D+/R- LT had similar risk of acute rejection (adjusted odds ratio [aOR], 0.87; P = .58), extracorporeal membranous oxygenation (aOR, 1.94; P = .10), and tracheostomy (aOR, 0.42; P = .16); similar median hospital stay (P = .07); and lower risk of ventilator > 48 hours (aOR, 0.68; P = .006). Adjusting for donor, recipient, and transplant characteristics, risk of all-cause graft failure and mortality were similar at 30 days, 1 year, and 3 years for HCV D+/R- versus HCV D-/R- LT (all P > .1), as well as for high- (≥20/year) versus low-volume LT centers and high- (≥5/year) versus low-volume HCV D+/R- LT centers (all P > .5).

Conclusions: HCV D+/R- and HCV D-/R- LT have similar outcomes at 3 years posttransplant. These results underscore the safety of HCV D+/R- LT and the potential benefit of expanding this practice further.

Keywords: donor pool; hepatitis C; lung transplant; outcomes.

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Conflict of interest statement

DISCLOSURE

The authors of this manuscript have no conflicts of interest to disclose as described by the Journal of Thoracic and Cardiovascular Surgery.

Figures

Figure 1.
Figure 1.
Identification of study population
Figure 2.
Figure 2.
Number of Lung Transplants from HCV-Viremic Donors for HCV-Seronegative Recipients Performed in the United States, by Year, 2015–2020
Figure 3.
Figure 3.
Number of U.S. Transplant Centers Performing Lung Transplants from HCV-Viremic and HCV-Seronegative Donors into HCV-Seronegative Recipients, by Year, 2015–2020. Of note, the number of transplant centers performing HCV D−/R− lung transplants is equivalent to the total number of transplant centers performing lung transplants in a given year.
Figure 4.
Figure 4.
Mortality among Recipients of HCV-Viremic and HCV-Seronegative Lung Transplants in the United States, 2015–2020, by Years since Transplant
Figure 5.
Figure 5.
All-Cause Graft Failure among Recipients of HCV-Viremic and HCV-Seronegative Lung Transplants in the United States, 2015–2020, by Years since Transplant
Figure 6.
Figure 6.
Visual Abstract
See this image and copyright information in PMC

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