Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, WA; Clinical and Bio-Analytics Transplant Laboratory (CBATL), University of Washington, Seattle, WA.
Clinical and Bio-Analytics Transplant Laboratory (CBATL), University of Washington, Seattle, WA; Divisions of Gastroenterology and Hepatology, Department of Medicine, University of Washington, Seattle, WA; Center for Liver Investigation Fostering DiscovEry (C-LIFE), University of Washington, Seattle, WA.
Surgery. 2019 Jul;166(1):102-108. doi: 10.1016/j.surg.2019.03.015. Epub 2019 May 6.
The opioid epidemic has resulted in increasing the incidence of hepatitis C virus in the general population and more deceased organ donors with hepatitis C in the United States. We aim to describe how the changing donor landscape affects patterns of liver and kidney transplantation among donors, waitlist candidates, and transplanted recipients.
Using data supplied by the United Network for Organ Sharing, we examined donor hepatitis C virus antibody (Ab) and nucleic acid testing (NAT) status, center waitlist patterns, and liver and kidney transplants and discards between 2015 and 2017 by 6-month periods.
We observed an increase in donors with any marker of the hepatitis C virus (n = 283 [6.2%] in period 1 to n = 384 [7.4%] in period 5, P = .008) and antibody positive nucleic acid testing negative donors (n = 81 [1.8%] in period 1 to n = 131 [2.5%] in period 5, P < .001). We observed a significant increase in aviremic recipients of liver transplants from antibody positive nucleic acid testing negative donors (n = 1 [1.7%] in period 1, to n = 27 [31.0%] in period 5, P = .005) and a significant decrease in the antibody positive nucleic acid testing positive liver discard rate (P = .01). By the end of the study, 75.8% (n = 97) of recipients of antibody positive nucleic acid testing negative kidneys were hepatitis C virus negative, an increase from 10.6% (n = 5) in period 1.
The number of donors with the hepatitis C virus is increasing. We observed a concomitant increase in the transplantation of kidneys and livers from aviremic donors, and the recipient population of these organs is increasingly hepatitis C virus negative.
阿片类药物泛滥导致美国普通人群中丙型肝炎病毒（hepatitis C virus，HCV）感染率上升，以及更多患有丙型肝炎的已故器官捐献者。我们旨在描述供体群体的变化如何影响美国供体、候补名单候选人以及移植受者的肝、肾移植模式。
我们使用美国器官共享网络（United Network for Organ Sharing）提供的数据，按 6 个月的时间段，检查了 2015 年至 2017 年期间供体 HCV 抗体（Ab）和核酸检测（NAT）状态、中心候补名单模式，以及肝、肾移植和移植器官废弃情况。
我们观察到具有 HCV 任何标志物的供体数量增加（第 1 个时间段为 283 例[6.2%]，第 5 个时间段为 384 例[7.4%]，P =.008），以及抗体阳性核酸检测阴性供体数量增加（第 1 个时间段为 81 例[1.8%]，第 5 个时间段为 131 例[2.5%]，P <.001）。我们观察到从抗体阳性核酸检测阴性供体接受肝移植的无 HCV 病毒血症受者显著增加（第 1 个时间段为 1 例[1.7%]，第 5 个时间段为 27 例[31.0%]，P =.005），而抗体阳性核酸检测阳性肝移植废弃率显著下降（P =.01）。研究结束时，75.8%（97 例）的抗体阳性核酸检测阴性肾移植受者 HCV 病毒阴性，高于第 1 个时间段的 10.6%（5 例）。
具有 HCV 病毒的供体数量在增加。我们观察到无 HCV 病毒血症供体的肝、肾移植数量增加，这些器官的受者人群 HCV 病毒阴性率增加。
