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:
      This paper is only available as a PDF. To read, Please Download here.



      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.


      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.


      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%).


      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

      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)