Impact of donor and recipient hepatitis C status in lung transplantation

https://doi.org/10.1016/j.healun.2015.10.012Get rights and content

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.

Section snippets

UNOS database

UNOS has maintained the Standard Transplant Analysis and Research files of waitlisted transplant candidates, recipients and donors in the USA since 1987.13 UNOS assures data quality through trained data abstracters and managers, quality checks and on-site auditing, and these prospective data are used to provide risk-adjusted performance measures.14

Study population

Using the UNOS database, all lung transplant cases from 1987 through 2011 were identified, with cases of pediatric and multiple-organ transplantation

Results

Of 16,604 transplant recipients without HCV, 28 recipients (0.2%) were transplanted with lungs from an HCV+ D. This use decreased significantly over time, from 0.73% during 1994 to 1996 to 0.06% from 2000 to 2011 (p < 0.001 for temporal trend in annual rate). HCV+ D had higher rates of tobacco abuse (64.3% vs 20.0%; p < 0.001) and trended toward older age (median: 36 vs 30 years; p = 0.072), but were otherwise similar. Recipients from the HCV+ D group were more likely to be on life support, in

Discussion

Lung transplant specialists are in the difficult position of weighing the needs of a challenging patient population and availability of a valuable but limited resource. The use of lung transplantation in HCV infection is rare, and this study we have described the trends in utilization, the patient population involved, and outcomes that can be expected. Use of HCV+ D in lung transplantation has decreased significantly, with only 3 cases recorded since 2005, whereas cases in HCV+ R have remained

Disclosure statement

The authors have no conflicts of interest to disclose. B.R.E. is partially supported by the National Institutes of Health (Grant U01 HL088942).

This study was presented at the 34th annual meeting and scientific sessions of the International Society for Heart and Lung Transplantation, April 2014, San Diego, California.

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