Treatment of hepatitis C in potential lung transplant candidates

International guidelines list hepatitis C virus (HCV) as a contraindication to lung transplant (LTx). Since the development of these guidelines, the natural history of HCV after nonhepatic transplant has been clarified, and more effective antiviral therapy is available. In renal transplant candidates, HCV treatment before transplantation improves post-transplant outcome. There are no data regarding the safety and efficacy of HCV therapy in LTx candidates. We describe the outcomes of HCV treatment in five LTx candidates. Three have had a sustained virologic response and there have been no unexpected adverse effects. Two have gone on to LTx. We conclude that selected lung transplant candidates can safely and effectively be treated for HCV before transplantation. An approach to selecting HCV-positive LTx candidates for antiviral therapy and transplant listing using clinical, virologic, and histologic data is described based on this experience and current knowledge regarding HCV natural history after solid organ transplant.