154: Pre-lung transplant immunosuppression assessment of candidates with risk of possible hepatitis C (HCV) post-transplantation

Abstract

Purpose: There is no consensus on evaluation of patients with HCV infection for lung transplantation. Immunosuppressive challenge (IC) was done to help predict which patients could be transplanted with minimal risk of post-transplant HCV sequelae. Methods and Materials: Patients who presented for lung transplant evaluation with possible risk of HCV disease post transplant were given a 6-week trial of Tacrolimus 2 mg bid and mycophenolate mofetil (MMF) 1000 mg bid. Outcome measures included changes in viral load, HCV RNA quantitative, bDNA, and evidence of hepatitis. Results: Patient 1: 64 year-old woman with emphysema and history of acute liver failure 22 years earlier with positive HCV antibody and no detectable viral load. Viral load was undetectable after IC and 1.5 years post transplant. Patient 2: 53 year-old man with lung fibrosis, positive HCV antibody and prior history of acute hepatitis B had undetectable viral load after IC and 11 months post transplant. Patient 3: 57 year-old man with emphysema, positive HCV antibody, viral load of 157,000 copies/ml, and no evidence of liver disease. With IC, viral load increased to 11.8 million copies/ml with abnormal liver function tests (LFT). Viral load and LFT returned to baseline post IC. Patient was transplanted at another institution. Viral load increased from 33,900 preto 4 million copies/ml 3-months post-transplant. Patient 4: 57 year old man with lung fibrosis, positive HCV antibody, viral load of 439,000 copies/ml, mild LFT abnormalities, and Grade II inflammation on liver biopsy. After MMF and prednisone treatment was initiated for lung disease, viral load increased to 64 million copies/ml associated with hepatitis. Patient was not offered transplant. Patient 5: 54 year-old man with emphysema and history of successful treatment of HCV hepatitis. No viral load elevation before or after IC. Patient awaiting transplant. Conclusions: Pre-transplantation immunosuppression may help determine which patients are at minimal risk of HCV disease following lung transplant.