• J. Thorac. Cardiovasc. Surg. · Jun 2024

    WTSA 2023: To Decline or Not To Decline: Consequences of Decision-Making Regarding Lung Offers from Donors with Hepatitis C.

    • Jessica M Ruck, Mary G Bowring, Christine M Durand, Jinny S Ha, Allan B Massie, Dorry L Segev, Christian A Merlo, and Errol L Bush.
    • Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
    • J. Thorac. Cardiovasc. Surg. 2024 Jun 1; 167 (6): 19671976.e21967-1976.e2.

    ObjectiveLung transplants from donors with hepatitis C (HCV D+) have excellent outcomes, but these organs continue to be declined. We evaluated whether (1) being listed to consider and (2) accepting versus declining HCV D+ offers provided a survival benefit to lung transplant candidates.MethodsUsing the Scientific Registry of Transplant Recipients, we identified all adult (≥18 years) lung transplant candidates 2016-2021 and compared waitlist mortality between those willing versus not willing to consider HCV D+ offers using competing risk regression. We identified all candidates offered an HCV D+ lung that was later accepted and followed them from offer decision until death or end-of-study. We estimated adjusted mortality risk of accepting versus declining an HCV D+ lung offer using propensity-weighted Cox regression.ResultsFrom 2016 to 2021, we identified 21,007 lung transplant candidates, 33.8% of whom were willing to consider HCV D+ offers. Candidates willing to consider HCV D+ offers had a 17% lower risk of waitlist mortality (subhazard ratio, 0.83; 95% confidence interval, 0.75-0.91, P < .001). Over the same period, 665 HCV D+ lung offers were accepted after being declined a total of 2562 times. HCV D+ offer acceptance versus decline was associated with a 20% lower risk of mortality (adjusted hazard ratio, 0.80; 95% confidence interval, 0.66-0.96, P = .02).ConclusionsConsidering HCV D+ lung offers was associated with a 17% lower risk of waitlist mortality, whereas accepting versus declining an HCV D+ lung offer was associated with a 20% lower risk of mortality. Centers and candidates should consider accepting suitable HCV D+ lung offers to optimize outcomes.Copyright © 2023 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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