Woolley Ann E, Piechura Laura M, Goldberg Hilary J, Singh Steve K, Coppolino Antonio, Baden Lindsey R, Mallidi Hari R
Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Ann Cardiothorac Surg. 2020 Jan;9(1):42-48. doi: 10.21037/acs.2020.01.03.
There is a low utilization rate of donated donor lungs. Historically, transplantation of lungs from hepatitis C-viremic donors to hepatitis C (HCV) negative recipients was avoided due to concern for worse graft survival. In the past few years with the advent of direct acting antiviral (DAA) therapy, there are emerging data suggesting the safety and efficacy of transplanting thoracic organs from HCV-viremic donors. This study assessed the differences in donor characteristics and allograft-specific clinical features at the time of organ offer and investigated whether these variables differed in HCV-viremic versus HCV-negative donors and impacted recipient outcomes.
We conducted a single-center, retrospective cohort study of adult patients who underwent a lung transplant at Brigham and Women's Hospital between March 2017 and October 2018. Patients were stratified based on their donor HCV status (HCV-viremic versus HCV-negative). Donor and allograft-specific characteristics and clinical features including chest imaging and bronchoscopy reports, respiratory cultures, and the donor's oxygenation as measured by the arterial partial pressure of oxygen (PaO) were collected as well as recipient baseline characteristics and transplant outcomes.
During the study period, 42 and 57 lung transplants were performed from HCV-viremic and HCV-negative donors, respectively. Donor age was similar in both cohorts. More HCV-viremic donors died from drug intoxication (71% versus 19%, P=0.0001) and had a history of cigarette use (83% versus 5%, P=0.0001) and drug use (76% versus 49%, P=0.007). There were differences in the baseline recipient characteristics including a lower median lung allocation score in the HCV-viremic cohort. The organ-specific clinical characteristics including the terminal PaO, chest imaging and bronchoscopy findings, and evidence of pulmonary infection were similar between the two cohorts. The recipient outcomes overall were excellent and did not differ significantly in both cohorts in terms of graft and patient survival at 6 and 12 months.
Despite a greater proportion of HCV-viremic donors being increased risk with a history of drug and cigarette use and having died as a result of drug intoxication, the quality of the HCV-viremic donor organs did not differ from the HCV-negative donor organs or impact graft and recipient survival. Due to an increasing number of transplants from increased risk donors and in order to develop safe and effective protocols to perform lung transplants from HCV-infected donors, further characterization of the donor and allograft-specific clinical features and longer-term recipient outcomes is greatly needed.
捐赠的供体肺利用率较低。从历史上看，由于担心移植肺存活情况较差，丙型肝炎病毒血症供体的肺不移植给丙型肝炎（HCV）阴性受体。在过去几年中，随着直接抗病毒药物（DAA）疗法的出现，有新数据表明从HCV病毒血症供体移植胸器官的安全性和有效性。本研究评估了器官供出时供体特征和移植器官特异性临床特征的差异，并调查了这些变量在HCV病毒血症供体与HCV阴性供体之间是否不同以及对受体结局的影响。
我们对2017年3月至2018年10月在布莱根妇女医院接受肺移植的成年患者进行了一项单中心回顾性队列研究。患者根据其供体HCV状态（HCV病毒血症与HCV阴性）进行分层。收集供体和移植器官特异性特征及临床特征，包括胸部影像学和支气管镜检查报告、呼吸道培养物，以及通过动脉血氧分压（PaO）测量的供体氧合情况，同时收集受体基线特征和移植结局。
在研究期间，分别从HCV病毒血症供体和HCV阴性供体进行了42例和57例肺移植。两个队列中的供体年龄相似。更多HCV病毒血症供体死于药物中毒（71%对19%，P = 0.0001），有吸烟史（83%对5%，P = 0.0001）和药物使用史（76%对49%，P = 0.007）。基线受体特征存在差异，包括HCV病毒血症队列中肺分配评分中位数较低。两个队列之间的器官特异性临床特征，包括终末PaO、胸部影像学和支气管镜检查结果以及肺部感染证据相似。总体受体结局良好，在6个月和12个月时，两个队列在移植肺和患者存活方面没有显著差异。
尽管HCV病毒血症供体中因药物和吸烟史而风险增加且死于药物中毒的比例更高，但HCV病毒血症供体器官的质量与HCV阴性供体器官无异，也未影响移植肺和受体存活。由于来自风险增加供体的移植数量不断增加，为了制定安全有效的方案来进行来自HCV感染供体的肺移植，非常需要进一步明确供体和移植器官特异性临床特征以及受体的长期结局。
