Impact of donor and recipient hepatitis C status in lung transplantation

Abstract

Background: Studies of lung transplantation in the setting of donors or recipients with hepatitis C virus (HCV) have been limited but have raised concerns about outcomes associated with this infection.

Methods: Lung transplant cases in the United Network for Organ Sharing (UNOS) database from 1994 to 2011 were analyzed for the HCV status of both donor and recipient. First, among HCV-negative recipients, those who received a lung from an HCV-positive donor (HCV(+) D) were compared with those who received an HCV-negative lung (HCV(-) D). Donor, recipient and operative characteristics as well as outcomes were compared between groups, and overall survival was compared after adjustment for confounders. In a second analysis, HCV-positive recipients (HCV(+) R) were compared with HCV-negative recipients (HCV(-) R). The analysis was stratified by era (1994 to 1999 and 2000 to 2011) and long-term survival was compared.

Results: Of 16,604 HCV-negative patients in the UNOS database, 28 (0.2%) received a lung from an HCV(+) D, with use of HCV(+) D decreasing significantly over time. Overall survival (OS) was shorter in the HCV(+) D group (median survival: 1.3 vs 5.1 years; p = 0.002). Results were confirmed in adjusted analyses. After inclusion criteria were met, 289 (1.7%) of the lung transplant recipients were HCV(+) R. These patients appeared similar to their HCV(-) R counterparts, except they were older and had more limited functional status. OS was significantly lower in HCV-positive individuals during the early era (median survival: 1.7 vs 4.5 years; p = 0.004), but not the recent era (median survival: 4.4 vs 5.4 years; p = 0.100). Again, results were confirmed by adjusted analysis.

Conclusions: HCV-positive status is a rare problem when considering both lung recipients and donors. Current data demonstrate significantly worse outcomes for HCV-negative patients receiving an HCV(+) lung; however, since 2000, HCV(+) recipients undergoing lung transplantation appear to have survival approximating that of HCV(-) recipients, an improvement from previous years. Recent medical advances in treatment for HCV may further improve outcomes in these groups.

Keywords: donor issues; donor pool expansion; hepatitis C; immunosuppression; lung transplant; outcomes; recipient selection; survival.

Conflict of interest statement

Disclosure statement

The authors have no conflicts of interest to disclose

Copyright © 2016 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

(A) Unadjusted Kaplan-Meier survival curve after lung transplantation by donor HCV status. Overall survival was significantly shorter in cases of lung transplantation from HCV+ donors by the log-rank test (p = 0.002). (B) Kaplan-Meier survival curve after lung transplantation by donor HCV status in the propensity-matched cohort. Overall survival was significantly shorter in cases of lung transplantation from HCV+ donors after propensity matching according to log-rank test (p = 0.026).

Figure 2

Unadjusted Kaplan–Meier survival curve after lung transplantation by recipient HCV status. Overall survival was similar in HCV+ vs HCV− recipients after 2000 by log-rank test (p = 0.100); however, HCV+ recipients had significantly decreased overall survival compared with HCV− recipients before 2000 according to log-rank test (p = 0.004).