Department of Pathology, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania.
Division of Transplantation, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania.
Clin Transplant. 2018 Sep;32(9):e13358. doi: 10.1111/ctr.13358. Epub 2018 Sep 10.
Kidney transplant from donors with hepatitis C virus (HCV) antibody has been limited to HCV viremic recipients only, due to concern of the HCV transmission. However, the new antiviral medications provide an opportunity to expand the utilization of these donors. To study the risk of HCV transmission in kidney transplantation, we used discarded donor kidneys and determined HCV RNA levels by quantitative real-time PCR in bilateral (right and left) kidney biopsies and plasma from 14 HCV antibody-positive donors (sensitivity: 15 international unit (IU)/mL plasma; 1.8 IU/50 nL kidney). In three NAT-negative donors, HCV RNA was negative in plasma and kidney. In all 11 NAT-positive donors, HCV RNA was positive in plasma (range: 5807-19 134 177 IU/mL) but negative in six kidneys from four donors with plasma HCV RNA <1.5 million IU/μL. HCV RNA correlated between right and left kidneys (P = 0.75) and between kidney and plasma (r = 0.86). When normalized by volume, HCV RNA median (range) was 49 (0-957) IU/50 nL plasma and 1.0 (0-103) IU/50 nL kidney, significantly lower in kidney (P = 0.005) than in plasma (14-fold). Plasma HCV RNA can be used to predict the kidney HCV load. Future studies are needed if plasma/kidney HCV levels can be used to stratify donors for transmission risk and recipients for post-transplant management in extended utilization of HCV antibody-positive donors.
由于担心丙型肝炎病毒 (HCV) 的传播，来自 HCV 抗体阳性供体的肾脏移植仅限于 HCV 病毒血症受者。然而，新的抗病毒药物为扩大这些供体的利用提供了机会。为了研究丙型肝炎病毒在肾移植中的传播风险，我们使用废弃的供体肾脏，并通过定量实时 PCR 在 14 例 HCV 抗体阳性供体的双侧（右肾和左肾）肾活检和血浆中测定 HCV RNA 水平（敏感性：15 国际单位 (IU)/mL 血浆；1.8 IU/50 nL 肾）。在 3 例 NAT 阴性供体中，血浆和肾脏 HCV RNA 均为阴性。在所有 11 例 NAT 阳性供体中，血浆 HCV RNA 均为阳性（范围：5807-19 134 177 IU/mL），但在 4 例血浆 HCV RNA <150 万 IU/μL 的供体的 6 个肾脏中均为阴性。右肾和左肾 HCV RNA 之间存在相关性（P=0.75），肾脏和血浆 HCV RNA 之间也存在相关性（r=0.86）。按体积校正后，HCV RNA 的中位数（范围）为血浆 49（0-957）IU/50 nL 和肾脏 1.0（0-103）IU/50 nL，肾脏中的 HCV RNA 明显低于血浆（P=0.005）（14 倍）。血浆 HCV RNA 可用于预测肾脏 HCV 负荷。如果可以使用血浆/肾脏 HCV 水平来对供体进行分层以预测传播风险，并对受者进行移植后管理，以扩大 HCV 抗体阳性供体的应用，则需要进一步研究。
