Should Lungs from Hepatitis C NAT+ Donors Continue to Be Transplanted? A UNOS Registry Analysis

Abstract

<h3>Purpose</h3> With the advent of a cure for HCV, HCV NAT+ donor lungs are being increasingly utilized for transplantation, but their outcomes are understudied. Our goal was to examine one-year survival of lung transplant recipients from HCV NAT+ donors. <h3>Methods</h3> We conducted retrospective review of all primary adult lung transplant recipients in the UNOS registry between January 1, 2015 and June 12, 2020. Donors were identified as being HCV NAT+ or HCV NAT-. One-year survival was examined with the Kaplan Meier method and a multivariable Cox-proportional hazards model. <h3>Results</h3> Of 11809 lung transplants performed during the study period, 222 (2%) came from HCV NAT+ donors. HCV NAT+ donors tended to be younger (33±8 vs 35±14 yrs, p=0.01) and were more likely to be white (82% vs 61%, p<0.01), blood group O (61% vs 50%, p<0.01), CDC high risk (84% vs 24%, p<0.01), and have drug intoxication as cause of death (61% vs 12%, p<0.01). Recipients of HCV NAT+ donor lungs were less likely to have diabetes (10% vs 20%, p<0.01), cystic fibrosis (5% vs 9%, p<0.01), IPF (28% vs 36%, p<0.01), have chronic steroid use (32% vs 44%) or be treated with IV antibiotics 2 weeks prior transplant (5% vs 12%, p=0.02). They had lower LAS scores (42±15 vs 48 ± 18, p<0.01), oxygen requirements at rest (4.5 vs 5.5 L, p<0.01), and were more likely to receive double lungs (83% vs 74%, p<0.01). One-year survival was not significantly different among recipients of HCV NAT+ and NAT- donor lungs on univariate (HR 1.00, 95% CI 0.62-1.62, p=0.98) or multivariate analysis (aHR 0.94, 95% CI 0.53-1.67, p=0.84). Incidence of treatment for acute rejection at one year was also not significantly different (23% vs 23%, p=0.86). <h3>Conclusion</h3> Despite coming from high-risk donors, HCV NAT+ lungs have similar one-year survival and acute rejection as those coming from HCV NAT- donors. While longer-term studies are necessary, this report supports the use of NAT+ donor lungs among lung transplant candidates.