National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and the NIHR Blood and Transplant Research Unit (BTRU) in Organ Donation and Transplantation at the University of Cambridge in collaboration with Newcastle University and in partnership with NHS Blood and Transplant (NHSBT), United Kingdom.
Organ Donation and Transplantation Directorate, NHS Blood and Transplant, United Kingdom.
Transplantation. 2018 Apr;102(4):664-672. doi: 10.1097/TP.0000000000002033.
Organs from hepatitis C virus (HCV) seropositive (HCVpos) individuals are seldom used for transplantation because of the risk of disease transmission. Because transmitted HCV is now amenable to effective treatment, we estimated the potential impact of using HCVpos deceased donor organs for transplantation.
The Potential Donor Audit of patients (<80 years) dying in UK critical care units and the UK Transplant Registry was searched to identify HCVpos potential and proceeding deceased donors. Donor organ quality was assessed using validated donor organ quality indices. Cost analysis was performed by comparing the cumulative cost of direct-acting antivirals with hemodialysis and renal transplantation.
Between 2009 and 2016, 120 patients identified from the Potential Donor Audit were not considered as potential donors because of the presence of HCV. Between 2000 and 2015, 244 HCVpos potential deceased donors were identified from the UK Transplant Registry, and 76 (31%) proceeded to donation, resulting in 63 liver, 27 kidney, and 2 heart transplants. Recipient and graft survival was not adversely impacted by donor HCVpos status. Most (69%) offered organs were declined because of positive virology although their quality was similar to that of other transplanted organs. The additional costs of treating recipients exposed to HCV by receiving a HCVpos kidney was cost-neutral with dialysis 5 years from transplantation.
HCVpos donors represent a potential source of organs for HCV seronegative recipients as many good quality HCVpos donor organs are not currently used for transplantation. This change in practice may increase access to transplantation without having an adverse effect on transplant outcome.
由于存在疾病传播的风险，来自丙型肝炎病毒（HCV）阳性（HCVpos）个体的器官很少用于移植。由于传播的 HCV 现在可以通过有效治疗，我们估计使用 HCVpos 已故供体器官进行移植的潜在影响。
在英国重症监护病房死亡的患者（<80 岁）的潜在供体审计和英国移植登记处进行了搜索，以确定 HCVpos 潜在和正在进行的已故供体。使用经过验证的供体器官质量指数评估供体器官质量。通过比较直接作用抗病毒药物与血液透析和肾移植的累积成本来进行成本分析。
在 2009 年至 2016 年间，从潜在供体审计中确定的 120 名患者由于 HCV 的存在而不被视为潜在供体。在 2000 年至 2015 年期间，从英国移植登记处确定了 244 名 HCVpos 潜在已故供体，其中 76 名（31%）进行了捐赠，导致 63 例肝、27 例肾和 2 例心脏移植。供体 HCVpos 状态并未对受者和移植物的存活产生不利影响。尽管他们的质量与其他移植器官相似，但由于病毒学阳性，大多数（69%）提供的器官被拒绝。接受 HCVpos 肾脏的 HCV 暴露受者的治疗费用与透析治疗 5 年后的成本相抵。
HCVpos 供体代表 HCV 阴性受者潜在的器官来源，因为目前许多高质量的 HCVpos 供体器官未用于移植。这种实践上的改变可能会增加移植的机会，而不会对移植结果产生不利影响。
