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Central Surgical Association

48th Annual Meeting

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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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ABOUT WTSA

The Western Thoracic Surgical Association (WTSA) was founded in 1974 and was originally named the Samson Thoracic Surgical Association. Read More

History
Constitution & Bylaws
Council & Committees
Annual Meeting
Membership Information
Members Only Area
Awards
Publications
Email WTSA Email WTSA
500 Cummings Center, Suite 4400, Beverly, MA 01915 500 Cummings Center
Suite 4400
Beverly, MA 01915, USA
+1 978-927-8330 +1 978-927-8330
+1 978-524-0498 +1 978-524-0498