Long-term outcomes of lung transplant recipients with hepatitis C infection: a retrospective study of the U.S. transplant registry.
Chronic hepatitis C patients in need of a lung transplant are often considered ineligible due to their infection.



To assess the association of hepatitis C virus (HCV) infection with long-term outcomes of lung transplants.



From the Scientific Registry of Transplant Recipients (1995-2011), we selected all adults with and without HCV infection who underwent lung transplantation.



A total of 17 762 lung transplant recipients were included (55.5% bilateral). Of those, 319 (1.83%) had positive HCV serology. The HCV-positive recipients were 1.6 years younger, less Caucasian and more African-American, and had a significantly higher rate of co-infection with hepatitis B virus (all P < 0.001). Post-transplant patients were discharged alive at similar rates regardless of HCV status: 88.4% in HCV+ vs. 90.3% in HCV- (P = 0.25). The mortality rates were also similar at 1 and 2 years after transplantation (20.7% in HCV+ vs. 19.2% in HCV- and 31.6% in HCV+ vs. 28.9% in HCV-, respectively; both P > 0.05), but at post-transplant year 3 year, mortality rate in HCV+ became significantly higher (42.5% vs. 36.4%, P = 0.04) and remained higher for the duration of the follow-up (mean 9.1 years, max 18.4 years). In multivariate survival analysis, after adjustment for confounders, being HCV+ was associated with higher mortality: adjusted hazard ratio 1.24 (1.04-1.46), P = 0.01. No association of HCV infection with time to graft loss was found (P = 0.92).



Chronic HCV infection is associated with a moderate increase in post-lung transplant mortality. Treatment of HCV in lung transplant recipients may, therefore, result in improvement of post-transplant outcomes.
Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
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Koenig
Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.|Center for Outcomes Research in Liver Diseases, Washington, DC, USA.
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Stepanova
Departments of Medicine and Surgery, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, CA, USA.
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Saab
Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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Ahmed
Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital Campus, Oakland, CA, USA.
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Wong
Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.|Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.
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Younossi
D000328:Adult; D000368:Aged; D060085:Coinfection; D005260:Female; D006085:Graft Survival; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology; D019698:Hepatitis C, Chronic / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D016040:Lung Transplantation / Q000401:mortality* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D066027:Transplant Recipients / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology