Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA.
Division of Gastroenterology and Hepatology, Department of Medicine, University of Washington, Seattle, WA.
Am J Transplant. 2017 Nov;17(11):2863-2868. doi: 10.1111/ajt.14386. Epub 2017 Jul 8.
Previous studies have grouped all donors positive for hepatitis C virus (HCV) antibody (Ab). Only recently has donor HCV nucleic acid testing (NAT) become routine, and the impact of Ab and NAT status on organ utilization is unknown. Using the United Network for Organ Sharing database, we identified 9290 donors from 2015 to 2016 for whom both HCV Ab and NAT data were available and compared organ utilization by HCV status. Overall, 93.8% of donors were Ab negative and NAT negative (Ab-NAT-), 0.15% were Ab negative and NAT positive, 1.8% were Ab positive and NAT negative (Ab+NAT-), and 4.2% were both Ab and NAT positive (Ab+NAT+). Ab-NAT- donors donated at the highest rate for all organs except livers, of which Ab+NAT- donors donated at a higher rate (81.2% vs 73.2%, p = 0.03). Livers were discarded for reasons related to abnormal biopsies in Ab+NAT+ donors, whereas kidneys from Ab- or NAT-positive donors were discarded for reasons related to HCV status. Using a propensity score-matched model, we estimated that using Ab+NAT- donors at the same rate as Ab-NAT- donors could result in 48 more kidney donors, 37 more heart donors, and 15 more lung donors annually. We urge the use of HCV Ab+NAT- donors for appropriately selected and consenting recipients.
先前的研究将所有丙型肝炎病毒（HCV）抗体（Ab）阳性的供者归为一组。直到最近，供者 HCV 核酸检测（NAT）才成为常规检测，而 Ab 和 NAT 状态对器官利用的影响尚不清楚。我们使用美国器官共享网络数据库，确定了 2015 年至 2016 年间 9290 名供者，他们均有 HCV Ab 和 NAT 数据，并比较了 HCV 状态下的器官利用情况。总体而言，93.8%的供者 Ab 和 NAT 均为阴性（Ab-NAT-），0.15%的供者 Ab 阴性而 NAT 阳性，1.8%的供者 Ab 阳性而 NAT 阴性（Ab+NAT-），4.2%的供者 Ab 和 NAT 均为阳性（Ab+NAT+）。除肝脏外，所有器官中 Ab-NAT-供者的捐献率最高，其中 Ab+NAT-供者的捐献率更高（81.2%对 73.2%，p=0.03）。Ab+NAT+供者的肝脏因活检异常而被丢弃，而 Ab-或 NAT 阳性供者的肾脏因 HCV 状态而被丢弃。使用倾向评分匹配模型，我们估计，以与 Ab-NAT-供者相同的比例使用 Ab+NAT-供者，每年可增加 48 名肾脏供者、37 名心脏供者和 15 名肺供者。我们敦促使用 HCV Ab+NAT-供者为适当选择和同意的受者。
