Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of California, San Diego, La Jolla, California.
Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, La Jolla, California.
J Heart Lung Transplant. 2019 Nov;38(11):1178-1188. doi: 10.1016/j.healun.2019.08.010. Epub 2019 Aug 14.
Previous studies suggest that direct-acting anti-virals (DAAs) for the treatment of hepatitis C virus (HCV) infection permits the transplantation of HCV-viremic donor organs in uninfected recipients. This opportunity may expand the donor pool. We assessed the impact of using HCV nucleic acid test-positive (NAT+) donor hearts on heart transplant (HTx) waitlist time and transplant rate.
We retrospectively analyzed 156 patients who were listed for HTx from October 2015 through October 2018. Patients were stratified into 2 periods centered on April 27, 2017, when the protocol to accept HCV NAT+ donor organs for transplantation in non-HCV-infected recipients began, Period 1 (October 27, 2015 to April 26, 2017) and Period 2 (April 27, 2017 to October 26, 2018).
In Period 1, 57 of the 71 patients on the HTx waitlist were transplanted, whereas in Period 2, 57 of the 85 patients were transplanted. The median waitlist time to transplant decreased from 63.1 days in Period 1 to 34.1 days in Period 2 (p = 0.002). The transplant rate increased from 168.2 per 100 patient-years in Period 1 to 280.0 per 100 patient-years in Period 2 (incidence rate ratio 2.0, 95% CI 1.2-3.3; p = 0.006). Waitlist mortality rate, hospital stay post-transplantation, and post-transplant mortality did not differ significantly between the time periods. Nineteen patients received HCV NAT+ donor hearts. The short-term post-transplant outcomes were similar between the recipients who received HCV NAT+ and HCV NAT- donor hearts.
This single-center retrospective analysis suggests that the use of HCV NAT+ donor hearts may result in a reduced HTx waitlist time and an increased transplant rate. In addition, transplanting HCV NAT+ donor hearts into non-HCV-infected recipients, followed by DAAs, can provide acceptable short-term post-transplant outcomes.
先前的研究表明，直接作用抗病毒药物（DAAs）治疗丙型肝炎病毒（HCV）感染可使 HCV 病毒载量阳性（NAT+）供体器官移植给未感染的受者。这一机会可能会扩大供体库。我们评估了使用 HCV 核酸检测阳性（NAT+）供心对心脏移植（HTx）候补名单时间和移植率的影响。
我们回顾性分析了 2015 年 10 月至 2018 年 10 月期间接受 HTx 的 156 名患者。患者分为两个时期，以 2017 年 4 月 27 日为中心，即开始接受 HCV NAT+供体器官用于非 HCV 感染受者移植的方案，时期 1（2015 年 10 月 27 日至 2017 年 4 月 26 日）和时期 2（2017 年 4 月 27 日至 2018 年 10 月 26 日）。
时期 1 中，71 名 HTx 候补名单患者中有 57 名接受了移植，而时期 2 中，85 名患者中有 57 名接受了移植。候补名单上的移植等待时间中位数从时期 1 的 63.1 天减少到时期 2 的 34.1 天（p=0.002）。移植率从时期 1 的每 100 患者年 168.2 例增加到时期 2 的每 100 患者年 280.0 例（发病率比 2.0，95%CI 1.2-3.3；p=0.006）。两个时期的候补名单死亡率、移植后住院时间和移植后死亡率无显著差异。19 名患者接受了 HCV NAT+供心。接受 HCV NAT+和 HCV NAT-供心的受者的短期移植后结局相似。
这项单中心回顾性分析表明，使用 HCV NAT+供心可能会缩短 HTx 候补名单时间并增加移植率。此外，将 HCV NAT+供体心脏移植给未感染 HCV 的受者，然后使用 DAA 治疗，可以提供可接受的短期移植后结局。
