Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, California, USA.
Division of Cardiovascular Medicine, Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
J Heart Lung Transplant. 2019 Dec;38(12):1259-1267. doi: 10.1016/j.healun.2019.08.019. Epub 2019 Aug 24.
National data demonstrate that increasing opportunities exist for organ donation among hepatitis C virus (HCV)-infected individuals.
We developed a clinical practice protocol for the acceptance of HCV+ organs for HCV- patients who underwent heart transplantation (HT) and retrospectively reviewed the outcomes at our institution. Inclusion criteria were as follows: all adult patients listed for HT. Exclusion criteria were as follows: pre-existing HIV or active hepatitis B viremia in the recipient/donor.
We transplanted 21 patients from HCV+ donors. Nineteen were viremic donors, and 2 were non-viremic donors. The recipients included 18 patients who underwent HT alone, and 3 patients who underwent combined heart-kidney transplants. There was no HCV transmission from the non-viremic donors (n = 2). All 19 recipients of the viremic donors developed HCV infection (100% transmission). The median age of the viremic donors was 34 years (interquartile range 30-46), and 84.2% were considered US Public Health Service-increased risk. Induction immunosuppression consisted of anti-thymocyte globulin (7/21), basiliximab (7/21), or none (8/21). Maintenance immunosuppression comprised tacrolimus, mycophenolate mofetil, and prednisone. Post-operative Week 2 HCV viral load was not related to induction. Direct anti-viral agent (DAA) therapy for a 12-week course consisted of glecaprevir/pibrentasvir (14/19, 74%), sofosbuvir/velpatasvir (2/19, 11%), elbasvir/grazoprevir (2/19, 11%), and ledipasvir/sofosbuvir (1/19, 5%). All the patients on DAA therapy cleared viremia. The sustained virological response rate at 12 weeks in 18 evaluable patients was 100%.
We report successful single-center experience using HCV+ organs for HT into HCV- recipients. We believe that there is utility in using such organs to expand the current donor pool. Further long-term follow-up is needed.
国家数据表明，丙型肝炎病毒 (HCV) 感染者的器官捐献机会越来越多。
我们为接受心脏移植 (HT) 的 HCV- 患者制定了接受 HCV+ 器官的临床实践方案，并回顾性分析了我们机构的结果。纳入标准如下：所有接受 HT 的成年患者。排除标准如下：受者/供者存在 HIV 感染或活动性乙型肝炎病毒血症。
我们从 HCV+ 供体中移植了 21 例患者。19 例为病毒血症供者，2 例为非病毒血症供者。受者包括 18 例单独接受 HT 的患者和 3 例同时接受心脏-肾脏移植的患者。非病毒血症供者无一例发生 HCV 传播（2 例，100%无传播）。19 例接受病毒血症供者的患者均发生 HCV 感染（100%传播）。病毒血症供者的中位年龄为 34 岁（四分位距 30-46），84.2%被认为是美国公共卫生服务增加风险人群。诱导性免疫抑制包括抗胸腺细胞球蛋白 (7/21)、巴利昔单抗 (7/21) 或无免疫抑制 (8/21)。维持性免疫抑制包括他克莫司、霉酚酸酯和泼尼松。术后第 2 周 HCV 病毒载量与诱导无关。12 周疗程的直接抗病毒药物 (DAA) 治疗包括格卡瑞韦/哌仑他韦 (14/19, 74%)、索磷布韦/维帕他韦 (2/19, 11%)、艾尔巴韦/格拉瑞韦 (2/19, 11%) 和来迪派韦/索磷布韦 (1/19, 5%)。所有接受 DAA 治疗的患者均清除了病毒血症。18 例可评估患者在 12 周时的持续病毒学应答率为 100%。
我们报告了单中心使用 HCV+ 器官进行 HT 治疗 HCV- 患者的成功经验。我们认为，利用这些器官扩大当前供体库是有用的。需要进一步进行长期随访。
