University of Wisconsin School of Medicine and Public Health and William S Middleton, VA Medical Center, Madison, WI, USA.
Transpl Infect Dis. 2021 Apr;23(2):e13466. doi: 10.1111/tid.13466. Epub 2020 Sep 25.
We report our experience utilizing liver donors with HCV Viremia (RNA+) for HCV-negative recipients (HCV D+R-) at a Veterans Affairs (VA) transplant center.
In 2018, we introduced an informed consent process for HCV D+R- liver transplants.
Eight HCV D+R- liver transplants (LT) were performed. Median time from listing to LT was 189 days (range 41-511). Median MELD at LT was 23.5 (median MELD at LT of 31 for center). All recipients developed HCV viremia after transplant. Median time to DAA initiation was 10 days after viremia (range 3-25). After transplant, the DAAs used were Mavyret in five recipients and Epclusa in three, all for 12 weeks. All eight patients completed DAA therapy and achieved negative HCV RNA by end of therapy (ETR) and seven reached sustained virologic response (SVR) by 12 weeks after end of therapy. One patient died from chronic ischemic encephalopathy after ETR, before SVR.
HCV D+R- is a practical strategy to expand the pool of donor organs. It shortened waiting time, allowing patients to receive transplants at lower MELD scores. VA liver transplant programs have provided universal and timely access to post-transplant HCV DAA therapy after donor-derived infection.
我们报告了在退伍军人事务部（VA）移植中心，利用 HCV 病毒血症（RNA+）的肝供体为 HCV 阴性受者（HCV D+R-）进行肝移植的经验。
2018 年，我们为 HCV D+R-肝移植引入了知情同意程序。
进行了 8 例 HCV D+R-肝移植（LT）。从列入名单到 LT 的中位时间为 189 天（范围 41-511）。LT 时的中位 MELD 为 23.5（中心的中位 MELD 为 31）。所有受者在移植后均出现 HCV 病毒血症。启动 DAA 的中位时间为病毒血症后 10 天（范围 3-25）。移植后，5 例患者使用 Mavyret，3 例患者使用 Epclusa，均为 12 周。所有 8 例患者均完成了 DAA 治疗，在治疗结束时（ETR）实现了 HCV RNA 阴性，7 例在 ETR 后 12 周达到了持续病毒学应答（SVR）。1 例患者在 ETR 后达到 SVR 之前因慢性缺血性脑病死亡。
HCV D+R-是扩大供体器官池的实用策略。它缩短了等待时间，使患者能够在较低的 MELD 评分下接受移植。VA 肝移植项目为受供体来源感染的患者提供了普遍且及时的移植后 HCV DAA 治疗。
