Patwardhan Vilas R, Curry Michael P
Transplant Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Curr Opin Organ Transplant. 2015 Jun;20(3):267-75. doi: 10.1097/MOT.0000000000000191.
Hepatitis C virus (HCV)-positive donor allografts may be considered for HCV-positive recipients, but are underutilized. With new effective antiviral treatments, we aim to review data on the use of HCV-positive allografts in solid organ transplantation and place them in the context of the changing HCV landscape.
Hepatitis C is the most common indication for liver transplant in the USA and Europe and a significant comorbidity in patients on the waitlist for nonliver solid organ transplantation. Patients with HCV on the waitlist for nonliver solid organ transplantation have worse outcomes compared with those without HCV. However, survival after transplantation is improved compared with those who remain on the waitlist. There has been concern that use of HCV-positive allografts would lead to worse post-transplant outcomes. However, more recent data suggest that transplant outcomes for recipients who accept HCV-positive donor allografts may be comparable with those who receive HCV-negative allografts. Emerging treatments to eradicate HCV have further improved the course of HCV-positive individuals, with improved efficacy and reduced side-effects.
In view of the changing landscape of hepatitis C treatment and reduced wait time on the transplant waiting lists for those accepting HCV-positive donors, future use of select HCV-positive donors in solid organ transplantation should be encouraged.
丙型肝炎病毒（HCV）阳性供体的同种异体移植物可考虑用于HCV阳性受者，但目前未得到充分利用。随着新型有效抗病毒治疗方法的出现，我们旨在回顾实体器官移植中使用HCV阳性移植物的数据，并将其置于不断变化的HCV形势背景下进行考量。
丙型肝炎是美国和欧洲肝移植最常见的适应证，也是非肝脏实体器官移植等待名单上患者的一种重要合并症。与无HCV的患者相比，非肝脏实体器官移植等待名单上的HCV患者预后更差。然而，与仍在等待名单上的患者相比，移植后的生存率有所提高。曾有人担心使用HCV阳性移植物会导致移植后预后更差。然而，最近的数据表明，接受HCV阳性供体移植物的受者的移植结局可能与接受HCV阴性移植物的受者相当。根除HCV的新兴治疗方法进一步改善了HCV阳性个体的病程，疗效提高且副作用减少。
鉴于丙型肝炎治疗形势的变化以及接受HCV阳性供体的患者在移植等待名单上等待时间的缩短，应鼓励未来在实体器官移植中选择性地使用HCV阳性供体。
