Multi-Organ Transplant Program, London Health Sciences Centre, University Hospital, London, ON, Canada.
Transplantation. 2011 Sep 27;92(6):686-9. doi: 10.1097/TP.0b013e31822a79d2.
In hepatitis C virus (HCV) recipients of donation after cardiac death (DCD) grafts, there is suggestion of lower rates of graft survival, indicating that DCD grafts themselves may represent a significant risk factor for severe recurrence of HCV.
We evaluated all DCD liver transplant recipients from August 2006 to February 2011 at our center. Recipients with HCV who received a DCD graft (group 1, HCV+ DCD, n=17) were compared with non-HCV recipients transplanted with a DCD graft (group 2, HCV- DCD, n=15), and with a matched group of HCV recipients transplanted with a donation after brain death (DBD) graft (group 3, HCV+ DBD, n=42).
A trend of poorer graft survival was seen in HCV+ patients who underwent a DCD transplant (group 1) compared with HCV- patients who underwent a DCD transplant (group 2) (P=0.14). Importantly, a statistically significant difference in graft survival was seen in HCV+ patients undergoing DCD transplant (group 1) (73%) as compared with DBD transplant (group 3) (93%)(P=0.01). There was a statistically significant increase in HCV recurrence at 3 months (76% vs. 16%) (P=0.005) and severe HCV recurrence within the first year (47% vs. 10%) in the DCD group (P=0.004).
HCV recurrence is more severe and progresses more rapidly in HCV+ recipients who receive grafts from DCD compared with those who receive grafts from DBD. DCD liver transplantation in HCV+ recipients is associated with a higher rate of graft failure compared with those who receive grafts from DBD. Caution must be taken when using DCD grafts in HCV+ recipients.
在接受心脏死亡供体（DCD）移植物的丙型肝炎病毒（HCV）受者中，移植物存活率较低，这表明 DCD 移植物本身可能是 HCV 严重复发的一个重要危险因素。
我们评估了 2006 年 8 月至 2011 年 2 月期间在我们中心接受 DCD 肝移植的所有患者。接受 DCD 移植物的 HCV 受者（第 1 组，HCV+DCD，n=17）与未感染 HCV 但接受 DCD 移植物的受者（第 2 组，HCV-DCD，n=15）进行比较，并与接受脑死亡供体（DBD）移植物的 HCV 受者匹配组（第 3 组，HCV+DBD，n=42）进行比较。
与接受 DCD 移植的未感染 HCV 受者（第 2 组）相比，接受 DCD 移植的 HCV 阳性受者（第 1 组）的移植物存活率呈下降趋势（P=0.14）。重要的是，接受 DCD 移植的 HCV 阳性患者（第 1 组）的移植物存活率与 DBD 移植患者（第 3 组）（93%）相比有显著差异（P=0.01）（73%）。DCD 组 HCV 复发率在 3 个月时（76%比 16%）（P=0.005）和第 1 年内（47%比 10%）有显著增加（P=0.004）。
与接受 DBD 移植物的受者相比，HCV+受者接受 DCD 移植物后 HCV 复发更严重，进展更快。与接受 DBD 移植物的受者相比，HCV+受者接受 DCD 肝移植后移植物失败的发生率更高。在 HCV+受者中使用 DCD 移植物时必须谨慎。
