Cohen Jordana B, Eddinger Kevin C, Shelton Brittany, Locke Jayme E, Forde Kimberly A, Sawinski Deirdre
Department of Medicine, Renal Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA, USA.
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Clin Kidney J. 2017 Aug;10(4):564-572. doi: 10.1093/ckj/sfx048. Epub 2017 Jul 11.
Hepatitis C virus (HCV) infection is common in dialysis patients and renal transplant recipients and has been associated with diminished patient and allograft survival. HCV-positive (HCV+) kidneys have been used in HCV-positive (HCV+) recipients as a means of facilitating transplantation and expanding the organ donor pool; however, the effect of donor HCV serostatus in the modern era is unknown.
Using national transplant registry data, we created a propensity score-matched cohort of HCV+ recipients who received HCV-positive donor kidneys compared to those transplanted with HCV-negative kidneys.
Transplantation with an HCV+ kidney was associated with an increased risk of death {hazard ratio [HR] 1.43 [95% confidence interval (CI) 1.18-1.76]; P < 0.001} and allograft loss [HR 1.39 (95% CI 1.16-1.67); P < 0.001] compared with their propensity score-matched counterparts. However, HCV+ kidneys were not associated with an increased risk of acute rejection [odds ratio 1.16 (95% CI 0.84-1.61); P = 0.35].
While use of HCV+ donor kidneys can shorten the wait for renal transplantation and maximize organ utility for all candidates on the waiting list, potential recipients should be counseled about the increased risks associated with HCV+ kidney.
丙型肝炎病毒（HCV）感染在透析患者和肾移植受者中很常见，并且与患者生存率降低和移植物存活减少有关。丙型肝炎病毒阳性（HCV+）的肾脏已被用于丙型肝炎病毒阳性（HCV+）的受者，作为促进移植和扩大器官供体库的一种手段；然而，在现代，供体HCV血清学状态的影响尚不清楚。
利用国家移植登记数据，我们创建了一个倾向评分匹配队列，将接受HCV阳性供体肾脏移植的HCV+受者与接受HCV阴性肾脏移植的受者进行比较。
与倾向评分匹配的对照组相比，接受HCV+肾脏移植的患者死亡风险增加{风险比[HR]1.43[95%置信区间（CI）1.18 - 1.76]；P < 0.001}，移植物丢失风险增加[HR 1.39（95%CI 1.16 - 1.67）；P < 0.001]。然而，HCV+肾脏与急性排斥反应风险增加无关[优势比1.16（95%CI 0.84 - 1.61）；P = 0.35]。
虽然使用HCV+供体肾脏可以缩短肾移植等待时间，并使等待名单上所有候选者的器官利用率最大化，但应向潜在受者告知与HCV+肾脏相关的风险增加情况。
