One‐year immunologic outcomes of lung transplantation utilizing hepatitis C‐viremic donors

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Abstract
Little is known about the effects of hepatitis C viremia on immunologic outcomes in the era of direct‐acting antivirals. We conducted a prospective, single‐arm trial of lung transplantation from hepatitis C‐infected donors into hepatitis C‐naïve recipients (n = 21). Recipients were initiated on glecaprevir‐pibrentasvir immediately post‐transplant and were continued on therapy for a total of 8 weeks. A control group of recipients of hepatitis C‐negative lungs were matched 1:1 on baseline variables (n = 21). The primary outcome was the frequency of acute cellular rejection over 1‐year post‐transplant. Treatment with glecaprevir‐pibrentasvir was well tolerated and resulted in viremia clearance after a median of 16 days of therapy (IQR 10–24 days). At one year, there was no difference in incidence of acute cellular rejection (71.4% vs. 85.7%, P = .17) or rejection requiring treatment (33.3% vs. 57.1%, P = .12). Mean cumulative acute rejection scores were similar between groups (.46 [SD ± .53] vs. .52 [SD ± .37], P = .67). Receipt of HCV+ organs was not associated with acute rejection on unadjusted Cox regression analysis (HR .55, 95% CI .28‐1.11, P = .09), or when adjusted for risk factors known to be associated with acute rejection (HR .57, 95% CI .27‐1.21, P = .14). Utilization of hepatitis C infected lungs with immediate treatment leads to equivalent immunologic outcomes at 1 year.

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