Trends in use and three-year outcomes of hepatitis C virus–viremic donor lung transplants for hepatitis C virus–seronegative recipients

Objective: The feasibility and 6-month outcome safety of lung transplants (LTs) from hepatitis C virus (HCV)-viremic donors for HCV-seronegative recipients (R–) were established in 2019, but longer-term safety and uptake of this practice nationally remain unknown. Methods: We identified HCV-seronegative LT recipients (R–) 2015-2020 using the Scientific Registry of Transplant Recipients. We classified donors as seronegative (D–) or viremic (D+). We used χ² testing, rank-sum testing, and Cox regression to compare posttransplant outcomes between HCV D+/R– and D–/R– LT recipients. Results: HCV D+/R– LT increased from 2 to 97/year; centers performing HCV D+/R– LT increased from 1 to 25. HCV D+/R– versus HCV D–/R– LT recipients had more obstructive disease (35.7% vs 23.3%, P < .001), lower lung allocation score (36.5 vs 41.1, P < .001), and longer waitlist time (P = .002). HCV D+/R– LT had similar risk of acute rejection (adjusted odds ratio [aOR], 0.87; P = .58), extracorporeal membranous oxygenation (aOR, 1.94; P = .10), and tracheostomy (aOR, 0.42; P = .16); similar median hospital stay (P = .07); and lower risk of ventilator > 48 hours (aOR, 0.68; P = .006). Adjusting for donor, recipient, and transplant characteristics, risk of all-cause graft failure and mortality were similar at 30 days, 1 year, and 3 years for HCV D+/R– versus HCV D–/R– LT (all P > .1), as well as for high- (≥20/year) versus low-volume LT centers and high- (≥5/year) versus low-volume HCV D+/R– LT centers (all P > .5). Conclusions: HCV D+/R– and HCV D–/R– LT have similar outcomes at 3 years posttransplant. These results underscore the safety of HCV D+/R– LT and the potential benefit of expanding this practice further.