Hepatitis C viremic lung transplantation to aviremic recipients: Comprehensive outcomes and post‐transplant viremia

Abstract Background/aims Direct‐acting antiviral (DAA) therapy has revolutionized solid organ transplantation by providing an opportunity to utilize organs from HCV‐viremic donors. Though transplantation of HCV‐viremic donor organs into aviremic recipients is safe in the short term, midterm data on survival and post‐transplant complications is lacking. We provide a midterm assessment of complications of lung transplantation (LT) up to 2 years post‐transplant, including patient and graft survival between HCV‐viremic transplantation (D+) and HCV‐aviremic transplantation (D‐). Methods This is a retrospective cohort study including 500 patients from 2018 to 2022 who underwent LT at our quaternary care institution. Outcomes of patients receiving D+ grafts were compared to those receiving D‐ grafts. Recipients of HCV antibody+ but PCR‐ grafts were treated as D‐ recipients. Results We identified 470 D‐ and 30 D+ patients meeting inclusion criteria. Crude mortality did not differ between groups ( p = .43). Patient survival at years 1 and 2 did not differ between D+ and D‐ patients ( p = .89, p = .87, respectively), and graft survival at years 1 and 2 did not differ between the two groups ( p = .90, p = .88, respectively). No extrahepatic manifestations or fibrosing cholestatic hepatitis (FCH) occurred among D+ recipients. D+ and D‐ patients had similar rates of post‐transplant chronic lung allograft rejection (CLAD) ( p = 6.7% vs. 12.8%, p = .3), acute cellular rejection (60.0% vs. 58.0%, p = .8) and antibody‐mediated rejection (16.7% vs. 14.2%, p = .7). Conclusion There is no difference in midterm patient or graft survival between D+ and D‐LT. No extrahepatic manifestations of HCV occurred. No differences in any type of rejection including CLAD were observed, though follow‐up for CLAD was limited. These results provide additional support for the use of HCV‐viremic organs in selected recipients in LT.