1 University of Minnesota, Department of Surgery, Division of Transplantation, Minneapolis, MN. 2 Research Division, United Network for Organ Sharing, Richmond, VA.
Transplantation. 2017 Jul;101(7):1670-1678. doi: 10.1097/TP.0000000000001716.
In 2013, the public health service (PHS) changed the criteria intended to identify organ donors that put the associated organ recipients at increased risk for acquiring human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). The changing donor demographics, organ utilization, and outcomes associated with this change are not known.
A review of the Organ Procurement and Transplantation Network database was performed to assess the impact of PHS donor designation on organ utilization and outcomes.
After the 2013 modification, over 20% of all deceased organ donors in the United States were identified as PHS increased risk. Compared with the standard risk deceased organ donor, the PHS donor was younger, male, died from anoxia, more likely to be HCV and antibody reacting to hepatitis B core antigen+, and less likely to have diabetes or hypertension. Organs from the 18- to 34-year-old deceased donors with PHS risks (but relatively few medical comorbidities) and tested negative for HCV were less frequently transplanted compared with the standard risk donors (3.9 vs 4.2 organs transplanted per donor). However, the transplant patient and graft survival as well as risk of unexpected transmission of HIV, HBV, and HCV were equivalent, irrespective of PHS donor status.
The rationale of using PHS donor designation that negatively impacts utilization of high-quality organs without the benefit of identifying the subset of organs with demonstrable proclivity to transmit HIV, HBV, or HCV needs to be reexamined.
2013 年，公共卫生服务（PHS）改变了旨在识别器官捐献者的标准，这些捐献者使相关器官受者感染人类免疫缺陷病毒（HIV）、乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）的风险增加。目前尚不清楚这种变化与相关的供者人口统计学变化、器官利用和结局有关。
对器官获取和移植网络数据库进行了回顾，以评估 PHS 供者分类对器官利用和结局的影响。
2013 年修订后，美国超过 20%的已故器官供者被确定为 PHS 高危。与标准风险的已故器官供者相比，PHS 供者年龄更小、男性、死于缺氧、更有可能感染 HCV 和乙型肝炎核心抗原抗体阳性，且不太可能患有糖尿病或高血压。与标准风险供者相比，来自 18-34 岁 PHS 风险（但相对较少的合并症）且 HCV 检测阴性的已故供者的器官移植频率较低（每供者移植 3.9 个器官与 4.2 个器官）。然而，无论 PHS 供者状态如何，移植患者和移植物存活率以及 HIV、HBV 和 HCV 意外传播的风险均相当。
使用 PHS 供者分类的理由是，它对高质量器官的利用产生负面影响，而没有确定具有明显传播 HIV、HBV 或 HCV 倾向的器官亚组，这一理由需要重新审查。
