Division of Kidney and Pancreas Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Clin Transplant. 2020 Aug;34(8):e13987. doi: 10.1111/ctr.13987. Epub 2020 Jun 16.
With increasing utilization of hepatitis C (HCV) viremic donor organs, there may be a role for kidney pump perfusion to reduce viral load and prevent HCV transmission. We performed a prospective pilot study of HCV viremic donors; one kidney from each donor pair was pumped with perfusate exchanges and viral load testing at least every 4 hours. Donor, recipient, and transplant characteristics were obtained with clinical outcomes. Linear regression was performed to quantify the association between pump time and perfusate viral load. Six HCV viremic donors for six pairs of aviremic recipients were included. Perfusate of the pumped kidneys showed detectable virus throughout the pump cycles. Although perfusate viral levels decreased with increasing pump times, this was not statistically significant (β = -.48, P = .36). All recipients had detectable HCV RNA postoperatively. The pumped cohort had an insignificantly reduced mean viral load compared to pumped recipients (1352 ± 2006 vs 26 170 ± 61 211, P = .09). Time to initiation of direct-acting antiviral was 32 ± 12 vs 26 ± 7 days (P = .17) and to undetectable levels was 66 ± 27 vs 55 ± 22 days (P = .82) for the pumped and unpumped cohorts, respectively. Pulsatile perfusion alone does not appear adequate to decrease HCV transmission. Future studies will need to explore additional ex vivo interventions to pumping.
随着丙型肝炎 (HCV) 病毒血症供体器官的应用增加，使用肾脏泵灌注来降低病毒载量并预防 HCV 传播可能具有一定作用。我们对 HCV 病毒血症供体进行了一项前瞻性的试点研究；每对供体的一个肾脏都进行了泵灌注，并至少每 4 小时进行一次病毒载量检测和交换。获取供体、受者和移植的特征，评估临床结局。进行线性回归来量化泵时间与灌注液病毒载量之间的关系。纳入了 6 名 HCV 病毒血症供体和 6 对非病毒血症受者。在整个泵循环过程中，灌注液中的泵肾脏都能检测到病毒。尽管随着泵时间的增加，灌注液中的病毒水平有所下降，但这并不具有统计学意义 (β=-.48，P=0.36)。所有受者术后均检测到 HCV RNA。与未泵血的受者相比，泵血组的平均病毒载量显著降低 (1352±2006 与 26170±61211，P=0.09)。开始直接作用抗病毒治疗的时间分别为 32±12 天和 26±7 天（P=0.17），未检测到病毒水平的时间分别为 66±27 天和 55±22 天（P=0.82），分别为泵血组和未泵血组。单独使用脉动灌注似乎不足以降低 HCV 传播。未来的研究将需要探索额外的离体干预泵灌注。
