One-year immunologic outcomes of lung transplantation utilizing hepatitis C-viremic donors.

Abstract

Little is known about the effects of hepatitis C viremia on immunologic outcomes in the era of direct-acting antivirals. We conducted a prospective, single-arm trial of lung transplantation from hepatitis C-infected donors into hepatitis C-naïve recipients (n=21). Recipients were initiated on glecaprevir-pibrentasvir immediately post-transplant and were continued on therapy for a total of 8weeks. A control group of recipients of hepatitis C-negative lungs were matched 1:1 on baseline variables (n=21). The primary outcome was the frequency of acute cellular rejection over 1-year post-transplant. Treatment with glecaprevir-pibrentasvir was well tolerated and resulted in viremia clearance after a median of 16 days of therapy (IQR 10-24 days). At one year, there was no difference in incidence of acute cellular rejection (71.4%vs. 85.7%, P=.17) or rejection requiring treatment (33.3%vs. 57.1%, P=.12). Mean cumulative acute rejection scores were similar between groups (.46 [SD ± .53] vs. .52 [SD± .37], P=.67). Receipt of HCV+ organs was not associated with acute rejection on unadjusted Cox regression analysis (HR .55, 95% CI .28-1.11, P=.09), or when adjusted for risk factors known to be associated with acute rejection (HR .57, 95% CI .27-1.21, P=.14). Utilization of hepatitis C infected lungs with immediate treatment leads to equivalent immunologic outcomes at 1 year.