Advertisement
JTCVS Open
Advanced searchSave search
Research Article|Articles in Press

Preemptive antiviral therapy in lung transplantation from hepatitis C donors results in a rapid and sustained virologic response

Open AccessPublished:March 09, 2023DOI:https://doi.org/10.1016/j.xjon.2023.02.014
Preemptive antiviral therapy in lung transplantation from hepatitis C donors results in a rapid and sustained virologic response
Previous ArticleOutcomes of Surgical Stabilization of Rib Fractures in a Minority Population: Retrospective Analysis of a Case Series from an Acute Care Facility
Next ArticleProgression of Distal Aorta after Endovascular Fenestration/Stenting in Acute Type A Aortic Dissection with malperfusion syndrome
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Objective

      To assess the safety and efficacy of a preemptive direct acting-antiviral therapy (DAA) in lung transplantation (LTx) from hepatitis C virus (HCV) donors into uninfected recipients.

      Methods

      This study is a prospective, open-label, non-randomized, pilot trial. Recipients of HCV nucleic acid testing (NAT)+ donor lungs underwent pre-emptive DAA therapy with glecaprevir 300mg/pibrentasvir 120mg for 8 weeks from January 1st, 2019, through December 31st, 2020. Recipients of NAT+ were compared with LTx from NAT- donors. Primary endpoints were Kaplan-Meier survival and sustained virologic response (SVR). Secondary outcomes included primary graft dysfunction, rejection, and infection.

      Results

      Fifty-nine LTx were included: 16 NAT+ and 43 NAT-. Twelve NAT+ recipients (75%) developed HCV viremia. Median time to clearance was 7 days. All NAT+ had undetectable HCV RNA by week 3 and all alive patients (n=15) remained negative during follow-up with 100% SVR at 12 months. One NAT+ patient died due to primary graft dysfunction and multiorgan failure. Three out of 43 NAT- (7%) had HCV antibody positive donors. None of them developed HCV viremia. One-year survival was 94% for NAT+, and 91% for NAT- recipients. There was no difference in primary graft dysfunction, rejection, or infection. NAT+ one-year survival was similar to an historical cohort of the Scientific Registry of Transplant Recipients (89%).

      Conclusion

      Recipients of HCV NAT+ lungs have similar survival to recipients of NAT- lungs. Preemptive DAA results in rapid viral clearance and SVR at 12 months. Preemptive DAA may partially prevent HCV transmission.

      Graphical abstract

      Figure thumbnail fx1
      Graphical Abstract

      Abbreviations and Acronyms:

      Ab (antibody), DAA (direct acting-antiviral), DCD (donation after circulatory death), EVLP (ex vivo lung perfusion), GP (glecaprevir-pibrentasvir), HCV (hepatitis C virus), LAS (lung allocation score), LTx (lung transplantation), NAT (nucleic acid testing), PGD (primary graft dysfunction), SRTR (scientific registry of transplant recipients), SVR (sustained virologic response)

      Article info

      Publication history

      Accepted: February 21, 2023
      Received: October 30, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Clinicaltrials.gov record number NCT03625687.

      Massachusetts General Hospital, Institutional Review Board, protocol number 2018P001697, approved January 3rd, 2019.

      Informed written consent was obtained from each patient to include their study data in research publications.

      Conflict of interest disclosure.

      Raymond T. Chung discloses grants or contracts from AbbVie, BMS, Janssen, Gilead, Merck, Boehringer in the last 36 months. He is part of the Governing Board of the American Association for the Study of Liver Diseases.

      Todd Astor discloses Participation on Merck’s Data Safety Monitoring Board or Advisory Board.

      Georgina Waldman discloses 2020-2021 ISHLT Program Planning Committee, unpaid.

      Thais Gift, consulting fees not related to this manuscript from eGenesis Bio.

      Funding

      There was no specific funding for this study. Stanly Wolfe is funded as the Martignetti Outcomes Cardiac Surgery Fellow. Raymond T. Chung was supported by the MGH Research Scholars Program

      Central Message

      Preemptive direct acting-antiviral therapy in lung transplantation recipients -from hepatitis C virus donors- results in a rapid viral clearance and sustained virologic response at 12 months.

      Perspective

      Lung transplant recipients are frequently maintained nil per os in the post-operative period. Direct acting-antiviral therapy requires administration as a crushed drug via a nasi-enteric tube, which is contrary to advice from manufacturers. Nonetheless, preemptive therapy results in rapid and sustained viral clearance. Futures studies of a shortened course might reduce cost and improve access.

      Central Picture Legend

      Preemptive antivirals in hepatitis C donor lung transplants results in a rapid response

      Identification

      DOI: https://doi.org/10.1016/j.xjon.2023.02.014

      Copyright

      © 2023 The Authors. Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery

      User license

      Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0) |
      How you can reuse Information Icon
      Creative Commons Attribution – NonCommercial – NoDerivs (CC BY-NC-ND 4.0)

      Permitted

      For non-commercial purposes:

      • Read, print & download
      • Redistribute or republish the final article
      • Text & data mine
      • Translate the article (private use only, not for distribution)
      • Reuse portions or extracts from the article in other works

      Not Permitted

      • Sell or re-use for commercial purposes
      • Distribute translations or adaptations of the article

      Elsevier's open access license policy

      ScienceDirect

      Access this article on ScienceDirect

      The content on this site is intended for healthcare professionals.


      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the Cookie Preference Center for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties.


      RELX