L'Huillier Arnaud G, Humar Atul, Payne Clare, Kumar Deepali
Division of Infectious Diseases, Hospital for Sick Children, Toronto, ON, Canada.
Multi-Organ Transplant Program, University of Heath Network, Toronto, ON, Canada.
Transpl Infect Dis. 2017 Dec;19(6). doi: 10.1111/tid.12785. Epub 2017 Nov 3.
Donors with an increased risk of transmitting human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV) (increased risk donors [IRDs]) are a potential source of organs for transplant. Organs from IRDs can be utilized with appropriate recipient consent and post-transplant follow-up. We reviewed the characteristics and utilization of IRDs in our Organ Procurement Organization (OPO) over a 2-year period.
Donor information from April 1, 2013 to March 31, 2015 was obtained through the OPO database. Only consented donors were included. Donors were categorized as IRDs according to Health Canada/Canadian Standards Association (CSA) criteria.
A total of 494 potential donors were identified, of which 92 (18.6%) were IRDs. Of these, at least one organ was transplanted from 76 (82.6%). Risk factors for IRDs included injection drug user (IDU) (12%), men having sex with men (MSM) (7%), commercial sex worker (CSW) (4%), and incarceration (24%). Fifty-nine percent (253/429) of IRD organs were utilized. The most frequently used organ was kidney, followed by liver. Median number of organs recovered per IRD was 3 (interquartile range: 2-5). Nucleic acid testing (NAT) was performed in 18.5% (17/92) of IRDs. Reasons for NAT were IDU (n = 2), MSM (n = 2), CSW (n = 2), and previous incarceration (n = 7). Organ utilization from donors that had NAT was similar to donors who did not (94% vs 80%, P = .29). Follow-up NAT was done in <5% of recipients from IRDs.
In our cohort, IRDs comprised a significant proportion of donors. Utilization of IRD organs occurred at a significant rate regardless of pre-transplant NAT. These data suggest that multiple factors contribute to the perception of infectious risk from such organs.
具有传播人类免疫缺陷病毒（HIV）、乙型肝炎病毒（HBV）或丙型肝炎病毒（HCV）风险增加的捐赠者（高风险捐赠者[IRD]）是潜在的移植器官来源。在获得接受者适当同意并进行移植后随访的情况下，可以使用来自IRD的器官。我们回顾了我们器官获取组织（OPO）在两年期间IRD的特征和利用情况。
通过OPO数据库获取2013年4月1日至2015年３月31日的捐赠者信息。仅纳入已同意的捐赠者。根据加拿大卫生部/加拿大标准协会（CSA）标准，将捐赠者分类为IRD。
共识别出494名潜在捐赠者，其中92名（18.6%）为IRD。其中，76名（82.6%）至少有一个器官被移植。IRD的风险因素包括注射吸毒者（IDU）（12%）、男男性行为者（MSM）（7%）、商业性工作者（CSW）（4%）和监禁（24%）。59%（253/429）的IRD器官被利用。最常用的器官是肾脏，其次是肝脏。每名IRD回收的器官中位数为3个（四分位间距：2-5）。18.5%（17/92）的IRD进行了核酸检测（NAT）。进行NAT的原因包括IDU（n = 2）、MSM（n = 2）、CSW（n = 2）和既往监禁（n = 7）。进行了NAT的捐赠者的器官利用率与未进行NAT的捐赠者相似（94%对80%，P = 0.29）。来自IRD的接受者中，<5%进行了随访NAT。
在我们的队列中，IRD占捐赠者的很大比例。无论移植前是否进行NAT,IRD器官的利用率都很高。这些数据表明，多种因素导致了对此类器官感染风险的认知。
