Ting Peng-Sheng, Hamilton James Peter, Gurakar Ahmet, Urrunaga Nathalie H, Ma Michelle, Glorioso Jaime, King Elizabeth, Toman Lindsey P, Wesson Russell, Garonzik-Wang Jacqueline, Ottmann Shane, Philosophe Benjamin, Sulkowski Mark, Cameron Andrew M, Durand Christine M, Chen Po-Hung
Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Transpl Infect Dis. 2019 Dec;21(6):e13194. doi: 10.1111/tid.13194. Epub 2019 Oct 30.
The opioid crisis has led to an increase in hepatitis C virus-positive donors in the past decade. Whereas historically hepatitis C seropositive organs were routinely discarded, the advent of direct-acting antiviral agents has notably expanded the utilization of organs from donors with hepatitis C. There has been growing experience with liver transplantation (LT) from hepatitis C seropositive donors to hepatitis C seropositive recipients. However, data remain limited on LT from hepatitis C seropositive or hepatitis C ribonucleic acid positive donors to hepatitis C seronegative recipients.
We performed a retrospective study of 26 hepatitis C seronegative recipients who received hepatitis C seropositive donor livers followed by preemptive antiviral therapy with direct-acting antiviral treatment at the Johns Hopkins Hospital Comprehensive Transplant Center from January 1, 2017, to August 31, 2019.
Twenty-five of the 26 recipients are alive with proper graft function; 20 of them received livers from hepatitis C nucleic acid testing positive donors. All 12 recipients who completed their direct-acting antiviral courses and have reached sufficient follow-up for sustained virologic response have achieved sustained virologic response. Nine of our recipients have either completed direct-acting antiviral treatment without sufficient follow-up time for sustained virologic response or are undergoing direct-acting antiviral treatment. One patient is awaiting antiviral treatment initiation pending insurance approval. Of note, 11 of 12 patients with sustained virologic response received a hepatitis C nucleic acid testing positive donor liver.
Hepatitis C seronegative patients who receive a hepatitis C seropositive or hepatitis C nucleic acid testing positive liver allograft can enjoy good short-term outcomes with hepatitis C cure following direct-acting antiviral treatment.
在过去十年中，阿片类药物危机导致丙型肝炎病毒阳性供体数量增加。以往丙型肝炎血清学阳性的器官通常会被丢弃，但直接抗病毒药物的出现显著扩大了丙型肝炎供体器官的利用率。丙型肝炎血清学阳性供体向丙型肝炎血清学阳性受体进行肝移植（LT）的经验越来越多。然而，关于丙型肝炎血清学阳性或丙型肝炎核糖核酸阳性供体向丙型肝炎血清学阴性受体进行肝移植的数据仍然有限。
我们对2017年1月1日至2019年8月31日在约翰霍普金斯医院综合移植中心接受丙型肝炎血清学阳性供体肝脏并随后接受直接抗病毒治疗进行抢先抗病毒治疗的26例丙型肝炎血清学阴性受体进行了回顾性研究。
26例受体中有25例存活且移植肝功能良好；其中20例接受了丙型肝炎核酸检测阳性供体的肝脏。所有12例完成直接抗病毒疗程且有足够随访时间以实现持续病毒学应答的受体均已实现持续病毒学应答。我们的9例受体要么已完成直接抗病毒治疗但没有足够的随访时间以实现持续病毒学应答，要么正在接受直接抗病毒治疗。1例患者正在等待保险批准后开始抗病毒治疗。值得注意的是，12例实现持续病毒学应答的患者中有11例接受了丙型肝炎核酸检测阳性供体的肝脏。
接受丙型肝炎血清学阳性或丙型肝炎核酸检测阳性肝脏同种异体移植的丙型肝炎血清学阴性患者在接受直接抗病毒治疗后实现丙型肝炎治愈，可获得良好的短期结局。
