Sedki Mai, Cortesi Camilo, O'Brien Christopher, Levy Cynthia, Martin Paul, Roth David, Bhamidimarri Kalyan Ram
From the Department of Internal Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.
Exp Clin Transplant. 2020 Mar 4. doi: 10.6002/ect.2019.0185.
Renal grafts from hepatitis C virus-positive deceased donors, which were once discarded, can now be transplanted into recipients and treated posttransplant due to the emergence of direct-acting antivirals, significantly improving wait list time and organ shortages. Here, we compared outcomes in hepatitis C virus-positive patients who received kidneys from hepatitis C virus-positive versus -negative donors.
In this single-center retrospective study, we divided 52 kidney transplant recipients who were viremic for hepatitis C virus pretransplant into 2 groups based on donors' hepatitis C virus serostatus (positive/negative). Demographics, time to transplant, efficacy of direct-acting antivirals, rejection episodes, immunosuppression adjustments, and renal function were assessed in both groups.
Our cohort included 50 patients receiving kidneys from deceased donors and 2 from living donors (1 related, 1 unrelated). Recipients of hepatitis C virus-positive kidneys had significantly less wait list time (36 days) than recipients of hepatitis C virus-negative kidneys (806 days; P < .001). All recipients responded well to direct-acting antivirals, with both groups showing similar sustained virologic response rates that were comparable to the general population. Intention-to-treat analyses showed rates of 91% and 100% in donor seropositive and donor seronegative groups, respectively (P = .273). Four antibody-mediated rejection episodes occurred in the donor seropositive and one mixed rejection in the donor seronegative group. Tacrolimus dose adjustments were required in 54% and 59% of recipients in the donor seropositive and seronegative groups, respectively. Recipients in the donor seropositive group had lower rates of worsening renal function than recipients in the donor seronegative group (11% vs 17.5%; P = .519).
In hepatitis C-positive recipients with donor negative or donor positive hepatitis C virus serostatus, response of direct-acting antiviral response was not significantly different and renal allograft function was maintained without any evidence of long-term adverse consequences to the graft.
曾经被丢弃的丙型肝炎病毒阳性已故供体的肾移植，由于直接作用抗病毒药物的出现，现在可以移植给受者并在移植后进行治疗，这显著缩短了等待名单时间并缓解了器官短缺问题。在此，我们比较了接受丙型肝炎病毒阳性供体肾脏与丙型肝炎病毒阴性供体肾脏的丙型肝炎病毒阳性患者的结局。
在这项单中心回顾性研究中，我们根据供体的丙型肝炎病毒血清学状态（阳性/阴性），将52例移植前丙型肝炎病毒血症的肾移植受者分为2组。评估了两组的人口统计学、移植时间、直接作用抗病毒药物的疗效、排斥反应发作、免疫抑制调整和肾功能。
我们的队列包括50例接受已故供体肾脏的患者和2例接受活体供体肾脏的患者（1例亲属供体，1例非亲属供体）。丙型肝炎病毒阳性肾脏的受者等待名单时间（36天）明显短于丙型肝炎病毒阴性肾脏的受者（806天；P <.001）。所有受者对直接作用抗病毒药物反应良好，两组的持续病毒学应答率相似，与普通人群相当。意向性分析显示，供体血清阳性组和供体血清阴性组的应答率分别为91%和100%（P =.273）。供体血清阳性组发生了4次抗体介导的排斥反应，供体血清阴性组发生了1次混合性排斥反应。供体血清阳性组和血清阴性组分别有54%和59%的受者需要调整他克莫司剂量。供体血清阳性组受者肾功能恶化的发生率低于供体血清阴性组（11%对17.5%；P =.519）。
在丙型肝炎病毒阳性受者中，无论供体丙型肝炎病毒血清学状态为阴性还是阳性，直接作用抗病毒药物的反应无显著差异，肾移植功能得以维持，且无任何移植长期不良后果的证据。
