HCV+ lungs transplants safe for noninfected recipients

  • Cypel M & al.
  • Lancet Respir Med
  • 9 Oct 2019

  • International Clinical Digest
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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.

Limitations

  • Monocentric design, small sample size.