SESSION TITLE: Pulmonary Pathology SESSION TYPE: Fellow Case Reports PRESENTED ON: 10/20/2019 1:00 PM - 2:00 PM INTRODUCTION: With the successful medical management of HIV, seropositivity is no longer a contraindication to solid-organ transplantation. Extrapolation from the experience of liver and kidney transplants with seropositive HIV patients over the past decade has laid the early foundation for heart and lung transplantation. Additionally, the development of Direct Acting Antivirals (DAAs) has made hepatitis C positive organ donation possible. CASE PRESENTATION: We describe the case of a 60 year old male with HIV, hypertension and progressive pulmonary fibrosis on supplemental oxygen who presented to our institution for lung transplant evaluation. He was diagnosed with HIV in 2003 and has been compliant on antiretrovirals with an undetectable viral load and high CD4 count. He denies a history of opportunistic infections or prior malignancies. His pre-transplant evaluation shows he is HCV negative, but is CMV and EBV positive. Latent Tuberculosis screening with Quantiferon Gold was positive, with no prior history of tuberculosis infection or treatment for LBTI. In preparation for transplant, his antiretrovirals were optimized to avoid drug-drug interactions with tacrolimus. He was consented to join our institution’s single center pilot study using Mavyret for 8 weeks as treatment for Lung Transplant Recipients with HCV positive donors. He was listed and received a single left lung transplant from a hepatitis C positive donor (also EBV+/CMV+). He was started on standardized transplant immunosuppression and prophylaxis, as well as Mavyret 3 tablets daily for treatment of Hepatitis C per our research protocol. His hospital course was overall uncomplicated. He is currently two months post -transplant with a stable FEV1, continued control of HIV with undetectable viral load with normal CD4 counts, and has completed his HCV treatment. He is now HCV antibody positive but with undetectable viral load. DISCUSSION: The experience from liver and kidney transplant in HIV positive persons has helped optimize patient selection characteristics, as well as, immunosuppressive and HAART regimen for post-transplant medical management. However, data for efficacy of lung transplantation in HIV seropositive patients is limited to a few published case studies worldwide. Furthermore, while hepatitis C donors represent a potential viable means to meaningfully increase donor availability, transplants from hepatitis C donors to seronegative recipients represents only a very small proportion of all lung transplants. CONCLUSIONS: Our case is unique, as it is the first case report, to our knowledge, of lung transplant from a hepatitis C positive donor to an HIV seropositive recipient. This case illustrates the clinical viability of using hepatitis C donors for lung transplantation in HIV recipients. Reference #1: Young KA, Dilling DF. The Future of Lung Transplantation. Chest. 2019;155(3):465-473. Reference #2: Koval C., Malinis M., Mueller N., Krisl J., Hannan M., Grossi P., Huprikar S. Heart and Lung Transplantation Outcomes in HIV-Positive Recipients Am J Transplant. 2017;17 (suppl 3). Reference #3: Kern RM, Seethamraju H, Blanc PD, Sinha N, Loebe M, Golden J, et al. The feasibility of lung transplantation in HIV-seropositive patients. Ann Am Thoracic Soc. 2014;11(6):882. DISCLOSURES: No relevant relationships by Luis Angel, source=Web Response No relevant relationships by Sangita Goel, source=Web Response No relevant relationships by Melissa Lesko, source=Web Response