使用丙型肝炎病毒抗体阳性供肝进行丙型肝炎非病毒血症肝移植受者。
Use of Hepatitis C Virus Antibody-Positive Donor Livers in Hepatitis C Nonviremic Liver Transplant Recipients.
机构信息
Department of Medicine and Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
Department of Medicine and Surgery, University of Cincinnati School of Medicine, Cincinnati, OH.
出版信息
J Am Coll Surg. 2019 Apr;228(4):560-567. doi: 10.1016/j.jamcollsurg.2018.12.004. Epub 2018 Dec 23.
BACKGROUND
Given the shortage of available liver grafts, transplantation (LTx) of hepatitis C virus antibody-positive, nucleic acid test-negative (HCV Ab+/NAT-) livers into nonviremic HCV recipients can expand the donor pool. Having previously described the sentinel experience of HCV Ab+/NAT- allografts in nonviremic recipients, we report the growth and extended follow-up of this program for 55 patients compared with recipients of Public Health Services (PHS) increased-risk donor HCV Ab-/NAT- allografts.
STUDY DESIGN
A prospective review of all HCV nonviremic LTx patients receiving HCV Ab+/NAT- organs between March 2016 and August 2018 was performed. All HCV Ab+/NAT- organ recipients underwent HCV testing at 3 months and 1-year post-LTx to determine HCV transmission.
RESULTS
Fifty-five HCV nonviremic candidates received HCV Ab+/NAT- organs; 64% male, median age 59 years (range 36 to 69 years) and median Model for End-Stage Liver Disease score of 22.5. Two recipients were excluded due to death before HCV testing. The HCV disease transmission occurred in 5 recipients (9%). Of these, 4 (80%) underwent anti-HCV treatment with eradication of virus. No patient found to be negative at 3 months seroconverted at 1-year follow-up. No patients who received PHS increased-risk donor HCV Ab-/NAT- organs had viremia develop (0 of 57) and there was no difference in graft and renal function, complications, or survival between HCV Ab+/NAT- recipients and PHS increased-risk donor HCV Ab-/NAT- recipients.
CONCLUSIONS
We report the largest experience with LTx from HCV Ab+/NAT- donors into 55 seronegative recipients with a HCV transmission rate of 9% with no late conversions at 1 year and no difference in function or graft loss compared with PHS increased-risk donor HCV Ab-/NAT- recipients. Due to availability of safe and effective HCV therapies, the use of such organs should be strongly considered to increase the donor organ pool.
背景
鉴于可用肝移植物的短缺，将丙型肝炎病毒抗体阳性、核酸检测阴性（HCV Ab+/NAT-）的肝脏移植到非病毒血症 HCV 受者体内，可以扩大供体库。我们之前描述了非病毒血症受者 HCV Ab+/NAT-同种异体移植物的先驱经验，在此我们报告了在 55 例患者中扩大该方案的经验，这些患者与接受公共卫生服务（PHS）高风险供体 HCV Ab-/NAT-同种异体移植物的患者相比。
研究设计
对 2016 年 3 月至 2018 年 8 月期间接受 HCV Ab+/NAT-器官的所有 HCV 非病毒血症 LTx 患者进行了前瞻性回顾。所有 HCV Ab+/NAT-器官受者在 LTx 后 3 个月和 1 年进行 HCV 检测，以确定 HCV 传播情况。
结果
55 例 HCV 非病毒血症候选者接受了 HCV Ab+/NAT-器官；64%为男性，中位年龄 59 岁（范围 36 至 69 岁），中位终末期肝病模型评分 22.5。由于 HCV 检测前死亡，有 2 例患者被排除在外。在 5 例受者中发生了 5 例 HCV 疾病传播（9%）。其中 4 例（80%）接受了抗 HCV 治疗，病毒被清除。在 1 年的随访中，没有在 3 个月时检测为阴性的患者出现血清转换。在接受 PHS 高风险供体 HCV Ab-/NAT-器官的患者中，没有人发生病毒血症（57 例均无），在 HCV Ab+/NAT-受者和 PHS 高风险供体 HCV Ab-/NAT-受者之间，在移植物和肾功能、并发症或存活率方面没有差异。
结论
我们报告了最大规模的经验，将 HCV Ab+/NAT-供体的肝脏移植到 55 例血清阴性受者中，HCV 传播率为 9%，在 1 年内无晚期转换，与 PHS 高风险供体 HCV Ab-/NAT-受者相比，在功能或移植物丢失方面无差异。由于安全有效的 HCV 治疗方法的可用性，应强烈考虑使用此类器官以增加供体器官库。
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