Transplantation of NAT+HCV Donor Lungs into Non-Infected Recipients Followed by Treatment with Sofosbuvir/Velpatasvir (S/V)

Purpose One of the most promising strategies to increase organ donation is the use of organs from donors with Hepatitis C (HCV). We evaluated the safety of transplanting NAT+HCV donors into non-infected lung recipients. Methods Between Oct 2017 and Oct 2018, NAT+HCV donors in North America were considered. Recipients consented to receive such organs under study protocol NCT03112044. Exclusion criteria included existence of liver disease or multi-organ transplant. Outcomes of study recipients were compared to patients receiving non-infected donors. Primary endpoints were survival and HCV status at 6 months after transplantation. All patients becoming viremic received S/V starting at least 2 weeks after transplantation. Results During the one-year study period 200 lung transplant procedures were performed at our center. Of these, 20 (10%) were from NAT+ HCV donors. Compared to standard donors, HCV donors were significantly younger (33y vs. 52y, p=0.002), more likely to be located in the United States vs. Canada (75% vs 5%, p=0.001), and more likely to be smokers (95% vs. 47%, p=0.0001). Donor P/F ratio (383 mmHg vs. 424 mmHg) and proportion of DCD (10% vs. 27%) were not statistically different between the 2 groups. Recipient age, lung disease, urgency status and positive donor HLA crossmatch were similar between the 2 groups. There was a significantly higher proportion of single lung transplants in the HCV group (55% vs. 15%, p=0.002). Post-transplant time on ventilation, ICU and hospital length of stay, use of ECMO and survival (100% in HCV group) were similar between the 2 groups. All patients, except 1 became viremic within 1 week after transplantation. 12 weeks treatment with S/V started at a median of 21 days after transplantation (range 14-71). All patients achieved negative HCV PCR from 2 to 6 weeks after treatment initiation. Two patients presented with HCV relapse within 3 months after S/V termination. One of the relapses was associated with alteration in liver enzymes. Conclusion Excellent intermediate-term clinical outcomes were achieved using NAT+HCV donors to non-infected recipients and this practice should continue to be encouraged. However, a higher relapse rate (10% to date) than previously reported in non-lung transplant patients was observed and novel strategies aiming at prevention of transmission should be further studied.