Fabrizi Fabrizio, Bunnapradist Suphamai, Lunghi Giovanna, Martin Paul
Division of Nephrology, Dialysis, Transplantation, Maggiore Hospital, IRCCS, Milan, Italy.
J Nephrol. 2003 Sep-Oct;16(5):617-25.
Hepatitis C Virus (HCV) infection is the most important cause of liver disease after renal transplantation (RT). The impact of HCV on patient and graft survival after RT remains controversial; however, the great majority of studies with large size and adequate follow-up have shown the detrimental impact of HCV on long-term patient and graft survival after RT. The use of kidneys from anti-HCV positive donors could help decrease the continuing disparity between the number of patients on the transplant waiting list and the number of patients receiving a transplant each year. Single-center experiences have suggested transplanting kidneys from anti-HCV positive donors only in anti-HCV positive dialysis patients. Such practice has not demonstrated any adverse effect on the short-term patient survival; the waiting times for RT were shortened. A better alternative seems to be a policy of transplanting kidneys from anti-HCV positive donors only in HCV RNA positive recipients. This requires HCV RNA testing of all anti-HCV positive dialysis patients awaiting RT. Matching donors and recipients for HCV genotype has been suggested; however, the assessment of donor HCV genotype is currently hampered by time constraints. Recent evidence based on large data base demonstrated that RT recipients of HCV-positive donors are at independent increased risk of mortality; unadjusted 3-year patient survival was 85% versus 93% (P=0.01) in all recipients of donor HCV-positive and HCV-negative kidneys, respectively. This was observed in all recipient subgroups including elderly and HCV-positive recipients. In the near future, rapid nucleic acid testing (NAT) of donors and recipients will allow the assessment of the HCV viremic status in order to maximize organ use. With appropriate informed consent, use of a renal graft from an HCV positive donor may be offered to an HCV infected recipient. Additional studies are needed to clarify the link between donor HCV-positive kidneys and patient mortality.
丙型肝炎病毒（HCV）感染是肾移植（RT）后肝病的最重要病因。HCV对RT后患者和移植物存活的影响仍存在争议；然而，绝大多数规模大且随访充分的研究表明，HCV对RT后患者和移植物的长期存活有不利影响。使用抗HCV阳性供体的肾脏有助于减少移植等待名单上的患者数量与每年接受移植的患者数量之间持续存在的差距。单中心经验表明，仅在抗HCV阳性的透析患者中移植抗HCV阳性供体的肾脏。这种做法尚未显示对患者短期存活有任何不良影响；RT的等待时间缩短了。一个更好的选择似乎是仅在HCV RNA阳性受者中移植抗HCV阳性供体肾脏的政策。这需要对所有等待RT的抗HCV阳性透析患者进行HCV RNA检测。有人建议对供体和受者的HCV基因型进行匹配；然而，目前由于时间限制，供体HCV基因型的评估受到阻碍。基于大型数据库的最新证据表明，HCV阳性供体的RT受者独立增加了死亡风险；在供体HCV阳性和HCV阴性肾脏的所有受者中，未经调整的3年患者存活率分别为85%和93%（P = 0.01）。在包括老年和HCV阳性受者在内的所有受者亚组中均观察到这一点。在不久的将来，供体和受者的快速核酸检测（NAT）将有助于评估HCV病毒血症状态，以最大限度地利用器官。在获得适当的知情同意后，可将HCV阳性供体的肾移植提供给HCV感染的受者。需要进一步的研究来阐明供体HCV阳性肾脏与患者死亡率之间的联系。
