Treatment of hepatitis C in potential lung transplant candidates

Area of Science:

• Transplantation immunology
• Hepatology
• Infectious diseases

Background:

• International guidelines contraindicate lung transplantation (LTx) for patients with hepatitis C virus (HCV).
• Advances in understanding HCV natural history post-transplant and development of effective antiviral therapies necessitate guideline re-evaluation.
• Pre-transplant HCV treatment improves outcomes in renal transplant recipients, but data for LTx candidates are lacking.

Purpose of the Study:

• To evaluate the safety and efficacy of treating HCV in lung transplant candidates.
• To describe an approach for selecting HCV-positive LTx candidates for antiviral therapy and transplant listing.

Main Methods:

• Retrospective case series of five LTx candidates undergoing HCV treatment.
• Assessment of treatment outcomes, including sustained virologic response (SVR) and adverse events.
• Development of a selection strategy based on clinical, virologic, and histologic data.

Main Results:

• Three of five patients achieved a sustained virologic response to HCV therapy.
• No unexpected adverse effects were observed during HCV treatment.
• Two patients successfully underwent lung transplantation after completing HCV treatment.

Conclusions:

• Selected lung transplant candidates can safely and effectively receive HCV treatment prior to transplantation.
• This strategy may improve outcomes for HCV-positive LTx candidates.
• A clinical, virologic, and histologic approach can guide the selection of candidates for pre-transplant HCV therapy and listing.