Hepatitis A

PURPOSE: Outcomes of Lung Transplant in Hepatitis C virus (HCV) positive Recipients is not known. We describe our experience with 5 such patients.

METHODS: Charts of LTR known to be HCV positive prior to transplantation were reviewed for demographics, HCV etiology, HCV RNA viral load pre and post transplantation, liver biopsy results, transaminase levels during various points post transplantation, the development of acute hepatitis and survival.

RESULTS: 454 lung transplants were performed during a 14 year period, only five patients (1%) [age (yrs [+ or -] SD): 48 [+ or -] 9.7, 3 females], were anti-HCV seropositive. Etiology of HCV infection included IVDA (n=l), unknown causes (n=4), and two patients had concomitant liver disease due to alpha-1-antitrypsin deficiency and cystic fibrosis. All patients were diagnosed with HCV prior to transplantation and confirmed with HCV qualitative RNA testing. All recipients had disease severity documented by liver biopsy (minimal peri portal fibrosis n=3, no cirrhosis n=5). The median duration from HCV diagnosis to transplantation was 2 years [inter quartile range, 1 to 8.2 yrs). Pre transplantation median quantitative HCV RNA levels were 50,300 IU/ml [inter quartile range, 16,897 to 200,780,000 IU/ml]. Post transplantation median quantitative HCV RNA level were noted to markedly increase [level (IU/ml): 2,470,000 IU/ml (inter quartile range, 646,825 to 2,897,500 IU/ml)]. There was no statistically significant increase in transaminase levels pre and post LTX despite increase in HCV RNA levels. The longest surviving_patient in this cohort is 5 yrs post transplantation, the shortest survival being 8 months. The patient died of respiratory complications with no evidence of hepatic failure at the time of death [mean survival (months [+ or -] SD): 32.6 [+ or -] 23.9].

CONCLUSION: Although viral loads tended to significantly increase post transplantation, there was no significant difference in the episodes of acute hepatitis, hepatic failure or cirrhosis during the duration of follow up. Post transplant monitoring of quantitative RNA HCV levels was not of any prognostic value.

CLINICAL IMPLICATIONS: Further studies are needed to provide guidelines for monitoring of this population post transplantation.

DISCLOSURE: Hina Sahi, None.

Hina Sahi MD * Marie Budev DO Holli Blazey Other Atul Mehta MBBS Cleveland Clinic Foundation, Cleveland, OH

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group