- HCV+ and HCV-negative lung transplants yield similar early and intermediate outcomes in noninfected recipients.
Why this matters
- Treatment of donor organs with ultraviolet C (UVC) perfusate irradiation during ex vivo lung perfusion (EVLP) significantly reduced viral load in transplant recipients.
- Prospective, open-label trial of 209 HCV-negative patients undergoing lung transplant; 22 patients received HCV+ grafts.
- 11 HCV+ donor lungs were treated with EVLP alone, and 11 with EVLP+UVC.
- Funding: Canadian Institutes of Health Research.
- Median wait-list time was shorter for HCV+ lungs (17 vs 42 days; P=.032).
- 20/22 (91%) of patients receiving HCV+ lungs developed viraemia within a week and received sofosbuvir/velpatasvir (Epclusa); median time to treatment was 21 days.
- EVLP+UVC vs EVLP was associated with significantly lower median viral load at day 7 (167 vs 4390 IU/mL; P=.048), and prevented transmission in 2 patients (18%).
- All achieved viral clearance within 6 weeks of treatment initiation; 2 relapsed and were retreated.
- At 6 months, 19/22 (86.4%) were alive and HCV-free.
- 6-month survival was similar with HCV+ and HCV-negative lungs (95.5% vs 94.1%).
- Grade 3/4 adverse events in recipients of HCV+ lungs most commonly included respiratory complications (n=5, 23%) and infection (n=4, 18%); 10 patients (45%) required readmission.
- Monocentric design, small sample size.