Hepatitis C virus infection and lung transplantation: A survey of practices

Background: Approximately 4 million persons in the United States are chroni cally infected with hepatitis C and morbidity due to this disease is increa singly observed in transplant recipients. While knowledge of hepatitis C in liver and kidney transplantation is advancing, little information is avail able concerning hepatitis C and lung transplantation. We surveyed lung tran splant programs about policies regarding testing for hepatitis C, transplan tation of hepatitis C-infected candidates, and the use of organs from serop ositive donors. Methods: A written questionnaire was sent to all United Network of Organ Sh aring (UNOS) approved lung transplant programs. Results: Fifty-nine of 89 (66%) surveys were returned, including 49 from ac tive programs, capturing 81% of lung transplants performed within UNOS prio r to January 1998. All programs screen candidates for hepatitis C. The esti mated median seropositivity rate among candidates was 1.9%. Thirty-three of 46 (72%) programs consider seropositive patients for transplantation and m ost use virologic and/or histologic data to determine candidacy. All donors are screened for hepatitis C. Twenty-six of 47 (55%) programs accept lungs from seropositive donors and many restrict the use of organs from seroposi tive donors to infected recipients. Few programs routinely test recipients for hepatitis C, and policies for monitoring those with known infection are variable. Conclusions: Lung transplant candidates and donors are tested routinely for hepatitis C. The majority of programs are willing to accept infected candi dates and seropositive donors. Post-transplant follow-up of hepatitis C is variable and prospective studies are needed to evaluate the impact of hepat itis C on lung transplant recipients.