Trends in Use and Long-Term Outcomes of HCV-Viremic Donor Lung Transplants for HCV-Seronegative Recipients
Jessica M. Ruck, Laura B. Zeiser, Christine M. Durand, Jinny S. Ha, Pali D. Shah, Allan B. Massie, Dorry L. Segev, Christian A. Merlo, *Errol L. Bush
Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
Objective: The feasibility and 6-month outcome equivalence of hepatitis C-viremic donor lung transplants (LTs) for HCV-seronegative recipients were established in 2019. However, the long-term safety of these LT has not been determined, and the uptake of this practice by transplant centers remains unknown.
Methods: We identified HCV seronegative LT recipients (R-) in the U.S. from 2015-2020 using the Scientific Registry for Transplant Recipients, classifying seronegative as a negative HCV antibody test. We then classified donors as seronegative (D-) or viremic (D+, reactive HCV nucleic acid test). We used Cox regression to compare the risk of post-transplant mortality and all-cause graft failure (ACGF) in HCV D+/R- and HCV D-/R- groups.
Results: The number of HCV D+/R- LT has increased steadily, from 2 in 2016 to 100 in 2020 (Table 1A). The number of transplant centers performing HCV D+/R- LT has increased over the same period, from 1 in 2016 to 25 in 2020 (Table 1B). Donor age was similar between groups, while donors in HCV D-/R- LT were more likely to be male (60.7% vs. 53.2%, p=0.02) and less likely to be of white race (60.8% vs. 80.7%, p<0.001, Table 2) than for HCV D+/R- LT. Obstructive lung disease was more common among HCV D+/R- LT recipients (35.4% vs. 23.5%, p<0.001). Waitlist time was similar between groups (p=0.1), with a trend toward longer waitlist times in HCV D+/R- LT recipients. Recipient characteristics were otherwise similar between groups. The proportion of recipients experiencing acute rejection was similar among HCV D-/R- and HCV D+/R- LT (7.8% vs. 6.8%, p=0.1). The risk of ACGF for HCV D+/R- vs. HCV D-/R- LT was similar at 30 days (HR 0.28, 95% CI 0.07-1.14, p=0.08), 1 year (HR 0.72, 95% CI 0.47-1.11, p=0.14), and 3 years (HR 0.75, 95% CI 0.54-1.05, p=0.09) post-transplant (Figure 1). Similarly, the risk of mortality for HCV D+/R- vs. HCV D-/R- LT was similar at 30 days (HR 0.28, 95% CI 0.07-1.14, p=0.08), 1 year (HR 0.74, 95% CI 0.48-1.13, p=0.13), and 3 years (HR 0.77, 95% CI 0.55-1.07, p=0.12) post-transplant (Figure 2). There were no significant differences in ACGF or mortality for HCV D+/R- LT when comparing centers performing >20 to <20 LT per year, or when comparing centers that had performed >5 HCV D+/R- LT in a year to those that had lower HCV D+/R- LT volumes (all p>0.5).
Conclusions: HCV D+/R- and HCV D-/R- lung transplants have statistically similar outcomes at 3 years post-transplant, with a trend toward lower likelihood of acute rejection, all-cause graft failure, and mortality for HCV D+/R- LT. These results underscore the safety of HCV D+/R- LT and the potential benefit of expanding the utilization of these donor lungs further.
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